Healthcare Provider Details

I. General information

NPI: 1215123922
Provider Name (Legal Business Name): SOLOMON,EDWARD M M D P A ETAL PT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SOUTH MAPLE AVE SUITE #4
RIDGEWOOD NJ
07450-4561
US

IV. Provider business mailing address

85 SOUTH MAPLE AVE SUITE #4
RIDGEWOOD NJ
07450-4561
US

V. Phone/Fax

Practice location:
  • Phone: 201-444-5898
  • Fax: 201-447-5775
Mailing address:
  • Phone: 201-444-5898
  • Fax: 201-447-5775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. BOYD H SEIDENBERG
Title or Position: PARTNER
Credential: MD
Phone: 201-444-5898