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General NPI Number Information
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NPI Number | 1710055470
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Entity Type | Organization
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Legal Business Name | NEIL H EDISON MD PA
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 06/23/2011
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Provider Practice Location Address
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Address Line | 3107 STIRLING ROAD SUITE 103
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City | FORT LAUDERDALE
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State | FL
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Zip | 33312-8500
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Country | US
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Telephone | 954-986-1179
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Fax | 954-986-1959
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Provider Business Mailing Address
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Address Line | 3107 STIRLING ROAD SUITE 103
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City | FORT LAUDERDALE
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State | FL
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Zip | 33312-8500
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Country | US
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Telephone | 954-986-1179
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Fax | 954-986-1959
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NEIL HARVEY EDISON
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Credential | MD
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Telephone | 954-986-1179
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME0015827
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License Number State | FL
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