Healthcare Provider Details

I. General information

NPI: 1821061110
Provider Name (Legal Business Name): CARRIE A EDELMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 05/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 HWY 70 BUILDING 11
WALL NJ
08736
US

IV. Provider business mailing address

2301 E. EVESHAM ROAD BLDG 800, SUITE 115
VOORHEES NJ
08043-4509
US

V. Phone/Fax

Practice location:
  • Phone: 856-424-5005
  • Fax: 856-424-4716
Mailing address:
  • Phone: 856-424-5005
  • Fax: 856-424-4716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number25MA07496200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: