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General NPI Number Information
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NPI Number | 1104231125
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Entity Type | Individual
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Provider Name | EDNER REGISTRE D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 06/28/2014
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Last Update Date | 06/01/2018
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Provider Practice Location Address
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Address Line | 11572 FRANCIS LEWIS BLVD
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City | CAMBRIA HEIGHTS
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State | NY
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Zip | 11411-1028
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Country | US
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Telephone | 718-276-8666
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Fax |
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Provider Business Mailing Address
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Address Line | 166 ROQUETTE AVE
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City | ELMONT
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State | NY
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Zip | 11003-1209
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Country | US
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Telephone | 347-679-5443
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 006837
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | R93136
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License Number State | NY
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