Provider Demographics
NPI:1417021627
Name:ENGLE, EDWARD I (DO)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:I
Last Name:ENGLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 BEACON AVENUE
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2626
Mailing Address - Country:US
Mailing Address - Phone:609-597-7110
Mailing Address - Fax:609-597-7113
Practice Address - Street 1:1145 BEACON AVENUE
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2626
Practice Address - Country:US
Practice Address - Phone:609-597-7110
Practice Address - Fax:609-597-7113
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07447800207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
8222873OtherGHI
103892OtherLOCAL 825
NJ0081299Medicaid
NJ2411891000OtherAMERIHEALTH
NJ2411891000OtherAMERIHEALTH
8222873OtherGHI