Healthcare Provider Details

I. General information

NPI: 1194712430
Provider Name (Legal Business Name): EDDY GARRIDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 08/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 HURFFVILLE CROSSKEYS RD
SEWELL NJ
08080-2337
US

IV. Provider business mailing address

445 HURFFVILLE CROSSKEYS RD
SEWELL NJ
08080-2337
US

V. Phone/Fax

Practice location:
  • Phone: 856-256-7591
  • Fax: 856-256-7585
Mailing address:
  • Phone: 856-256-7591
  • Fax: 856-256-7585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD019333E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number25MA09749600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: