Healthcare Provider Details

I. General information

NPI: 1013012772
Provider Name (Legal Business Name): EDWARD J GINDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1636 E 14TH ST STE 108
BROOKLYN NY
11229-1100
US

IV. Provider business mailing address

1636 E 14TH ST STE 108
BROOKLYN NY
11229-1100
US

V. Phone/Fax

Practice location:
  • Phone: 718-376-6425
  • Fax: 718-376-6427
Mailing address:
  • Phone: 718-376-6425
  • Fax: 718-376-6427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number149046
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number149046
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: