Healthcare Provider Details

I. General information

NPI: 1366755357
Provider Name (Legal Business Name): EDGAR BARAYA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2010
Last Update Date: 07/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 LAFAYETTE AVE
BRONX NY
10473-2008
US

IV. Provider business mailing address

2045 LAFAYETTE AVE
BRONX NY
10473-2008
US

V. Phone/Fax

Practice location:
  • Phone: 718-904-9032
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number155449
License Number StateNY

VIII. Authorized Official

Name: EDGAR BARAYA
Title or Position: MD
Credential:
Phone: 718-904-9032