Provider Demographics
NPI:1215371851
Name:EDISON MEDICAL CARE, LLC
Entity Type:Organization
Organization Name:EDISON MEDICAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYOUNG
Authorized Official - Middle Name:J
Authorized Official - Last Name:SON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-632-8090
Mailing Address - Street 1:2 STATE ROUTE 27 STE 110
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3976
Mailing Address - Country:US
Mailing Address - Phone:732-632-8090
Mailing Address - Fax:732-632-8096
Practice Address - Street 1:2 STATE ROUTE 27 STE 110
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3976
Practice Address - Country:US
Practice Address - Phone:732-632-8090
Practice Address - Fax:732-632-8096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-25
Last Update Date:2013-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04367100207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ052993Medicare PIN