Healthcare Provider Details

I. General information

NPI: 1669469557
Provider Name (Legal Business Name): EDWIN KOLODNY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 E 34TH ST 2 FL
NEW YORK NY
10016-4972
US

IV. Provider business mailing address

403 E 34TH ST 2 FL
NEW YORK NY
10016-4972
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-8344
  • Fax:
Mailing address:
  • Phone: 212-263-8344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number091581
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: