Provider Demographics
NPI:1538270319
Name:EDNALINO, LINDA (MD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:EDNALINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 10 SHOREFRONT PARKWAY
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-1531
Mailing Address - Country:US
Mailing Address - Phone:718-318-6336
Mailing Address - Fax:718-318-6337
Practice Address - Street 1:10710 SHORE FRONT PKWY
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2637
Practice Address - Country:US
Practice Address - Phone:718-318-6336
Practice Address - Fax:718-318-6337
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153923-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00803443Medicaid
NY00803443Medicaid
NYA60146Medicare UPIN