MEDICARE: DR. MICHAEL BENJAMIN EDYE MD

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	208600000X	Surgery Physician	203491	NY

General Provider Information

NPI Number	:	1427051762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL BENJAMIN EDYE MD

Provider Business Mailing Address
First Line	:	5 E 98TH ST
Second Line	:	BOX 1259
City	:	NEW YORK
State	:	NY
Zip	:	10029-6501
Country	:	US
Telephone Number	:	212-241-6591
Fax Number	:	212-534-2654

Provider Business Practice Location Address
First Line	:	5 E 98TH ST
Second Line	:	BOX 1259
City	:	NEW YORK
State	:	NY
Zip	:	10029-6501
Country	:	US
Telephone Number	:	212-241-6591
Fax Number	:	212-534-2654

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	02/12/2009

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