Healthcare Provider Details

I. General information

NPI: 1093648370
Provider Name (Legal Business Name): MAGDIE EDOUARD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21310 92ND AVE
QUEENS VILLAGE NY
11428-1110
US

IV. Provider business mailing address

118 N WALDINGER ST
VALLEY STREAM NY
11580-3849
US

V. Phone/Fax

Practice location:
  • Phone: 718-465-0651
  • Fax:
Mailing address:
  • Phone: 516-524-6851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: