Healthcare Provider Details

I. General information

NPI: 1578353835
Provider Name (Legal Business Name): NJ PREVENTIVE HEALTH EDGE MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2025
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 ROUTE 73 N STE 117
MARLTON NJ
08053-3422
US

IV. Provider business mailing address

525 ROUTE 73 N STE 117
MARLTON NJ
08053-3422
US

V. Phone/Fax

Practice location:
  • Phone: 917-310-5621
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: BENJAMIN STEIN
Title or Position: PRESIDENT
Credential: MD
Phone: 917-310-5621