Provider Demographics
NPI:1033275300
Name:EDWARDS, JENNIFER LORRAINE (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LORRAINE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BLUEBERRY LN
Mailing Address - Street 2:
Mailing Address - City:LEONARDO
Mailing Address - State:NJ
Mailing Address - Zip Code:07737-1804
Mailing Address - Country:US
Mailing Address - Phone:732-708-9781
Mailing Address - Fax:
Practice Address - Street 1:661 SHREWSBURY AVE.
Practice Address - Street 2:MERIDIAN BEHAVIORAL HEALTH,
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702
Practice Address - Country:US
Practice Address - Phone:732-345-3400
Practice Address - Fax:732-345-3401
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMAO604732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJED865660Medicare ID - Type Unspecified