=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932837770
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDWARD JONES LP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2022
-----------------------------------------------------
Last Update Date | 08/10/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7 GARDINERS LN
-----------------------------------------------------
City | EAST HAMPTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11937-1711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-228-4222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 GARDINERS LN
-----------------------------------------------------
City | EAST HAMPTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11937-1711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-228-4222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 102L00000X
-----------------------------------------------------
Taxonomy Name | Psychoanalyst
-----------------------------------------------------
License Number | 001139
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------