Healthcare Provider Details

I. General information

NPI: 1710055470
Provider Name (Legal Business Name): NEIL H EDISON MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 06/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3107 STIRLING ROAD SUITE 103
FORT LAUDERDALE FL
33312-8500
US

IV. Provider business mailing address

3107 STIRLING ROAD SUITE 103
FORT LAUDERDALE FL
33312-8500
US

V. Phone/Fax

Practice location:
  • Phone: 954-986-1179
  • Fax: 954-986-1959
Mailing address:
  • Phone: 954-986-1179
  • Fax: 954-986-1959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME0015827
License Number StateFL

VIII. Authorized Official

Name: DR. NEIL HARVEY EDISON
Title or Position: PRESIDENT
Credential: MD
Phone: 954-986-1179