Healthcare Provider Details

I. General information

NPI: 1497466858
Provider Name (Legal Business Name): EDISON NEUROLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2022
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CAREWELL HEALTH MEDICAL CENTER 300 CENTRAL AVENUE
EAST ORANGE NJ
07018
US

IV. Provider business mailing address

17 ANNA LN
EDISON NJ
08820-1503
US

V. Phone/Fax

Practice location:
  • Phone: 973-672-8400
  • Fax:
Mailing address:
  • Phone: 908-672-0403
  • Fax: 908-756-6879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HASMUKH SUTARIA
Title or Position: OWNER
Credential: MD
Phone: 908-672-0403