Provider Demographics
NPI:1881701845
Name:EDWARDS, HENRY E (MD PSYCHIATRIST)
Entity type:Individual
Prefix:MR
First Name:HENRY
Middle Name:E
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MD PSYCHIATRIST
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Mailing Address - Street 1:684 S MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-5724
Mailing Address - Country:US
Mailing Address - Phone:516-498-9461
Mailing Address - Fax:718-352-2590
Practice Address - Street 1:6800 JERICHO TPKE
Practice Address - Street 2:STE 122W
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4445
Practice Address - Country:US
Practice Address - Phone:516-498-9461
Practice Address - Fax:718-352-2590
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2099852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3189161OtherGHI
NY74M921Medicare ID - Type UnspecifiedMEDICARE