Healthcare Provider Details

I. General information

NPI: 1922601269
Provider Name (Legal Business Name): EDWIN GIRARD RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 COOPER ST
BABYLON NY
11702-2327
US

IV. Provider business mailing address

155 COOPER ST
BABYLON NY
11702-2327
US

V. Phone/Fax

Practice location:
  • Phone: 732-731-9741
  • Fax:
Mailing address:
  • Phone: 732-731-9741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279P3900X
TaxonomyNeonatal/Pediatric Registered Respiratory Therapist
License Number009726-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: