MEDICARE: CYNTHIA EDWARDS OTR

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	174400000X	Specialist	006190-1	NY

General Provider Information

NPI Number	:	1801055835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA EDWARDS OTR

Provider Business Mailing Address
First Line	:	4041 BAYCHESTER AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-2313
Country	:	US
Telephone Number	:	718-655-1362
Fax Number	:	718-515-3868

Provider Business Practice Location Address
First Line	:	4041 BAYCHESTER AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-2313
Country	:	US
Telephone Number	:	718-655-1362
Fax Number	:	718-515-3868

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

Provider Enumeration Date	:	06/05/2008
Last Update Date	:	06/05/2008

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