Provider Demographics
NPI:1275526568
Name:MARON, EDWARD M (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:M
Last Name:MARON
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 1:500 RIVER AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4743
Mailing Address - Country:US
Mailing Address - Phone:732-363-7200
Mailing Address - Fax:732-363-8183
Practice Address - Street 1:500 RIVER AVE STE 140
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4743
Practice Address - Country:US
Practice Address - Phone:732-363-7200
Practice Address - Fax:732-363-8183
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40456207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1288903Medicaid
NJC52750Medicare UPIN
C52750Medicare UPIN
NJ1288903Medicaid