Healthcare Provider Details

I. General information

NPI: 1548911985
Provider Name (Legal Business Name): EDISON HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 LINCOLN HWY
EDISON NJ
08817-3212
US

IV. Provider business mailing address

2090 ROUTE 27
EDISON NJ
08817-3372
US

V. Phone/Fax

Practice location:
  • Phone: 732-662-5650
  • Fax:
Mailing address:
  • Phone: 732-662-5650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KHALID M AZIZ
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 732-662-5650