Provider Demographics
NPI:1962130369
Name:WARREN, EDINE (CM)
Entity type:Individual
Prefix:
First Name:EDINE
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1307 PACIFIC ST APT 5G
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-3151
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:226 GRANT AVE FL 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-1809
Practice Address - Country:US
Practice Address - Phone:646-334-5921
Practice Address - Fax:272-254-4788
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MM00003700367A00000X
NY002149367A00000X
L-308270174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No174N00000XOther Service ProvidersLactation Consultant, Non-RN