Provider Demographics
NPI:1093973174
Name:SHEN, EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:SHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-3453
Mailing Address - Country:US
Mailing Address - Phone:908-818-1600
Mailing Address - Fax:908-818-1601
Practice Address - Street 1:219 S BROAD ST
Practice Address - Street 2:SUITE 2
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-3453
Practice Address - Country:US
Practice Address - Phone:201-877-0518
Practice Address - Fax:908-352-6181
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09306300207LP2900X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine