Healthcare Provider Details

I. General information

NPI: 1255326591
Provider Name (Legal Business Name): EDUARD POROSNICU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 12/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 LENOX RD
BROOKLYN NY
11203-2017
US

IV. Provider business mailing address

445 LENOX RD BOX 1262
BROOKLYN NY
11203-2017
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-1531
  • Fax:
Mailing address:
  • Phone: 718-270-1531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberMD19906
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number256355
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: