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General NPI Number Information
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NPI Number | 1548546286
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Entity Type | Organization
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Legal Business Name | EDISON FAMILY PRACTICE
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Dates
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Enumeration Date | 10/26/2011
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Last Update Date | 01/11/2012
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Provider Practice Location Address
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Address Line | 616 GROVE AVE
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City | EDISON
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State | NJ
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Zip | 08820-3212
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Country | US
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Telephone | 732-548-6303
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Fax | 732-549-4676
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Provider Business Mailing Address
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Address Line | 616 GROVE AVE
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City | EDISON
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State | NJ
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Zip | 08820-3212
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Country | US
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Telephone | 732-548-6303
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Fax | 732-549-4676
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARIA S FLORES DIEPPA
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Credential | MD
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Telephone | 732-548-6303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MA45007
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License Number State | NJ
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