Provider Demographics
NPI:1245920115
Name:SOLEIMANIAN, EDAN
Entity type:Individual
Prefix:
First Name:EDAN
Middle Name:
Last Name:SOLEIMANIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 TIDEWAY ST
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11024-1118
Mailing Address - Country:US
Mailing Address - Phone:516-749-8565
Mailing Address - Fax:
Practice Address - Street 1:11 TIDEWAY ST
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11024-1118
Practice Address - Country:US
Practice Address - Phone:516-749-8565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program