Healthcare Provider Details

I. General information

NPI: 1538383674
Provider Name (Legal Business Name): EDGE ORTHOTICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 FARVIEW TER
PARAMUS NJ
07652-2713
US

IV. Provider business mailing address

PO BOX 293
EAST RUTHERFORD NJ
07073-0293
US

V. Phone/Fax

Practice location:
  • Phone: 732-549-3343
  • Fax: 732-549-6555
Mailing address:
  • Phone: 732-549-3343
  • Fax: 732-549-6555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number45OR00008400
License Number StateNJ

VII. Legacy identifiers

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

# 1
Identifier7017291
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerCIGNA
# 2
Identifier1491
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerMASTERCARE
# 3
Identifier36469
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerANTHEM
# 4
Identifier01000611600
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerAMERICHOICE
# 5
IdentifierA-52767
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerMULTIPLAN
# 6
Identifier1110724
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerHORIZON NJ HEALTH
# 7
Identifier0559903
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer
# 8
Identifier15200
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerUNIVERSITY HEALTH PLANS
# 9
Identifier2K5581
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerHEALTHNET
# 10
Identifier43669
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerAMERIGROUP

VIII. Authorized Official

Name: MARTHA GARCIA
Title or Position: OWNER
Credential:
Phone: 732-549-3343