Individual provider Active NPI

Eda Gulu

  • Medical Physician Assistant
  • New York, NY
National Provider Identifier
1720714181
Registry record updated Jul 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
525 E 68TH St
New York, NY 10065-4870
Phone
(212) 746-5454
NPI assigned
Jul 28, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X Primary

Addresses

Primary practice location

525 E 68TH St
New York, NY 10065-4870

Mailing address

2839 Bragg St
Brooklyn, NY 11235-1101
Phone (646) 884-1540

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240910002395 NY Practitioner - Physician Assistant 6507232204 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
State University of New York at Stony Brook, School of Medicine, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Divinity Medical Services PLLCGroup PAC ID 5193030245, 92 clinicians

Practice addresses (Care Compare)

13337 41St Ave
Flushing, NY 11355-3630
Phone (347) 996-6840

13525 79TH St
Howard Beach, NY 11414-1010
Phone (917) 309-5662

1585 Dutch Broadway
Valley Stream, NY 11580-1333
Phone (516) 490-6300

2128 Rockaway Pkwy
Brooklyn, NY 11236-5802
Phone (718) 489-8820

23315 Hillside Ave
Queens Village, NY 11427-2634
Phone (718) 210-1945

3379 Crompond Rd
Yorktown Heights, NY 10598-3605
Phone (914) 930-5550

464 Atlantic Ave
East Rockaway, NY 11518-1415
Phone (516) 730-3344

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1658966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658966400000",
    "number": "1720714181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2839 BRAGG ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112351101",
            "telephone_number": "646-884-1540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 E 68TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100654870",
            "telephone_number": "212-746-5454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GULU",
        "first_name": "EDA",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-28",
        "last_updated": "2022-07-28",
        "certification_date": "2022-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.