MEDICARE: MR. EDNER REGISTRE D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	006837	NY
2	213E00000X	Podiatrist	R93136	NY

General Provider Information

NPI Number	:	1104231125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDNER REGISTRE D.P.M.

Provider Business Mailing Address
First Line	:	166 ROQUETTE AVE
Second Line	:
City	:	ELMONT
State	:	NY
Zip	:	11003-1209
Country	:	US
Telephone Number	:	347-679-5443
Fax Number	:

Provider Business Practice Location Address
First Line	:	11572 FRANCIS LEWIS BLVD
Second Line	:
City	:	CAMBRIA HEIGHTS
State	:	NY
Zip	:	11411-1028
Country	:	US
Telephone Number	:	718-276-8666
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2014
Last Update Date	:	06/01/2018

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