Provider Demographics
NPI:1407101371
Name:EDGECOMB, KAREN L (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:EDGECOMB
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:L
Other - Last Name:SALAZAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1875 MOUNTAIN TOP RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2348
Mailing Address - Country:US
Mailing Address - Phone:732-926-0608
Mailing Address - Fax:
Practice Address - Street 1:2624 HIGHWAY 516
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2306
Practice Address - Country:US
Practice Address - Phone:732-952-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00286800363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant