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NPI Code Detail

MEDICARE: DR. EDWARD FIROUZTALE DO

MEDICARE: DR. EDWARD FIROUZTALE DO
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
12084N0400XNeurology Physician215019NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154395382
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EDWARD FIROUZTALE DO
Provider Business Mailing Address
First Line : 712 MAIN ST
Second Line :
City : ISLIP
State : NY
Zip : 11751-3620
Country : US
Telephone Number : 631-666-3939
Fax Number : 631-666-3994
Provider Business Practice Location Address
First Line : 712 MAIN ST
Second Line :
City : ISLIP
State : NY
Zip : 11751-3620
Country : US
Telephone Number : 631-666-3939
Fax Number : 631-666-3994
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2006
Last Update Date : 06/09/2016

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Directions to “ DR. EDWARD FIROUZTALE DO” Practice Location

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