Healthcare Provider Details

I. General information

NPI: 1376915553
Provider Name (Legal Business Name): DR. EDWARDS AT WAYNE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2015
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 HAMBURG TPKE
WAYNE NJ
07470-2098
US

IV. Provider business mailing address

705 HAMBURG TPKE
WAYNE NJ
07470-2098
US

V. Phone/Fax

Practice location:
  • Phone: 973-922-1000
  • Fax:
Mailing address:
  • Phone: 973-922-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MAGDY MAHMOUD
Title or Position: CEO
Credential:
Phone: 973-650-2009