Eden Health Medical of de PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

EDEN HEALTH MEDICAL OF DE PA

Practice address

77 Goodell St Ste 510
Buffalo, NY 14203-1258

Phone

(917) 261-4414

NPI assigned

Oct 19, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Rajan Shah, MD

Title

President

Phone

(917) 261-4414

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1634601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726185600000",
    "number": "1285397976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 GOODELL ST STE 510",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142031258",
            "telephone_number": "917-261-4414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 GOODELL ST STE 510",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142031258",
            "telephone_number": "917-261-4414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDEN HEALTH MEDICAL OF DE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-19",
        "last_updated": "2024-09-13",
        "certification_date": "2024-09-13",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "RAJAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "917-261-4414",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ecmc Foundation Inc
• Thomas Joseph Edd, M.D.
• Oluwapelumi Edebo Carrena
• Brian M Edelstein, M.D.
• Eden Health Medical of DC PC
• Eden Health Medical of Ma PC
• Eden Health Medical of NJ PC
• Eden Health Medical of VA PC
• Susan Ederer, RN
• Stephen B Edge, MD

• Internal Medicine Physician in Buffalo, NY
• Providers in Buffalo, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.