Individual
EDISON TYLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
375 SEGUINE AVE, STATEN ISLAND, NY 10309-3932
(718) 226-2000
Mailing address
151 MORANI ST, STATEN ISLAND, NY 10314-1672
(646) 369-3611
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
431757
NY
Other
Enumeration date
07/09/2020
Last updated
07/09/2020
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