Individual
KODE R. EDIALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
153 W. 11TH ST., NEW YORK, NY 10011
(212) 604-7566
Mailing address
P.O. BOX 270, MASSAPEQUA PARK, NY 11762
(631) 264-2035
(631) 264-1418
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
172178
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01112761
—
NY
Enumeration date
09/27/2006
Last updated
09/07/2007
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