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General NPI Number Information
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NPI Number | 1427398189
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Entity Type | Organization
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Legal Business Name | EDWARD L. LUNDY, D.O.
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Dates
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Enumeration Date | 02/18/2013
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Last Update Date | 02/18/2013
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Provider Practice Location Address
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Address Line | 1017 MARKET ST
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City | GLOUCESTER CITY
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State | NJ
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Zip | 08030-1847
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Country | US
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Telephone | 856-456-1042
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Fax | 856-546-4896
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Provider Business Mailing Address
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Address Line | 1017 MARKET ST
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City | GLOUCESTER CITY
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State | NJ
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Zip | 08030-1847
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Country | US
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Telephone | 856-456-1042
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Fax | 856-456-8830
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Authorized Official
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Title or Position | OWNER
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Name | DR. EDWARD L. LUNDY
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Credential | D.O.
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Telephone | 856-456-1042
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ00143400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MB35070
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License Number State | NJ
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