Healthcare Provider Details

I. General information

NPI: 1316995392
Provider Name (Legal Business Name): EDGARDO DELEON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 SHERMAN AVE
VINELAND NJ
08360
US

IV. Provider business mailing address

PO BOX 8500 4056
PHILADELPHIA PA
19178-4056
US

V. Phone/Fax

Practice location:
  • Phone: 856-363-1000
  • Fax:
Mailing address:
  • Phone: 302-709-4505
  • Fax: 302-733-0854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA04163200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: