Provider Demographics
NPI:1265848121
Name:EDWARDS, JESSICA I (DO)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:I
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:129 W 29TH ST FL 10
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-5105
Mailing Address - Country:US
Mailing Address - Phone:415-658-6791
Mailing Address - Fax:415-520-0904
Practice Address - Street 1:165 SMITH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-6337
Practice Address - Country:US
Practice Address - Phone:212-441-4380
Practice Address - Fax:212-867-4353
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR4689207Q00000X
NY287148207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine