Provider Demographics
NPI:1134504772
Name:DANIEL EDWARDS DO PC
Entity Type:Organization
Organization Name:DANIEL EDWARDS DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MAGDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHMOUD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:973-650-2009
Mailing Address - Street 1:705 HAMBURG TPKE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2098
Mailing Address - Country:US
Mailing Address - Phone:973-650-2009
Mailing Address - Fax:253-650-2009
Practice Address - Street 1:705 HAMBURG TPKE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2098
Practice Address - Country:US
Practice Address - Phone:973-650-2009
Practice Address - Fax:253-650-2009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-24
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8234400Medicaid
NJ037602Medicare PIN