Provider Demographics
NPI:1427398189
Name:EDWARD L. LUNDY, D.O.
Entity Type:Organization
Organization Name:EDWARD L. LUNDY, D.O.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:LUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-456-1042
Mailing Address - Street 1:1017 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08030-1847
Mailing Address - Country:US
Mailing Address - Phone:856-456-1042
Mailing Address - Fax:856-456-8830
Practice Address - Street 1:1017 MARKET ST
Practice Address - Street 2:
Practice Address - City:GLOUCESTER CITY
Practice Address - State:NJ
Practice Address - Zip Code:08030-1847
Practice Address - Country:US
Practice Address - Phone:856-456-1042
Practice Address - Fax:856-546-4896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-18
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB35070207Q00000X
NJ26NJ00143400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty