John Benjamin Edwards
General Practice in Woodside, NY. Individual provider (NPI-1).
NPI number1497345136
StatusActive
Last updated in NPPESJan 26, 2021
Details
- NPI
- 1497345136
- Entity type
- Individual (NPI-1)
- Name
- John Benjamin Edwards
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jan 26, 2021
- Certification date
- Jan 26, 2021
- Last updated
- Jan 26, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208D00000X | General Practice | 287268 | NY | Yes |
Practice location
3975 56th St Apt 4bWoodside, NY 11377-8900
Phone 646-627-4985
Mailing address
3975 56th St Apt 4bWoodside, NY 11377-8900
Phone 164-662-7498
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