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General NPI Number Information
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NPI Number | 1093430837
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Entity Type | Organization
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Legal Business Name | EDEN TREE MEDICAL
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Dates
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Enumeration Date | 10/04/2022
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | 107 RIDGE RD
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City | VALLEY COTTAGE
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State | NY
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Zip | 10989-2466
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Country | US
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Telephone | 845-770-4686
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Fax |
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Provider Business Mailing Address
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Address Line | 107 RIDGE RD
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City | VALLEY COTTAGE
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State | NY
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Zip | 10989-2466
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Country | US
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Telephone | 845-770-4686
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT, COO
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Name | MARTIN SHERIDAN
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Credential | RN
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Telephone | 917-693-5738
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number |
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License Number State |
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