Healthcare Provider Details

I. General information

NPI: 1952257495
Provider Name (Legal Business Name): JERNIER EDWARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2026
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2177 OAK TREE RD STE 206
EDISON NJ
08820-1082
US

IV. Provider business mailing address

5422 BARLEYCORN DR
RICHMOND VA
23227-2559
US

V. Phone/Fax

Practice location:
  • Phone: 848-372-5930
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number25MA08065400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: