Provider Demographics
NPI:1457303919
Name:VERNER, EDWINA (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWINA
Middle Name:
Last Name:VERNER
Suffix:
Gender:F
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:PO BOX 3155
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07019-3155
Mailing Address - Country:US
Mailing Address - Phone:973-414-1886
Mailing Address - Fax:
Practice Address - Street 1:86 S HARRISON ST
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1704
Practice Address - Country:US
Practice Address - Phone:973-414-1886
Practice Address - Fax:973-674-6134
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA038021002080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1194996645Other444 WILLIAM STREET
NM1740345693Other741 BROADWAY
NJ1932370483Other101 LUDLOW STREET
NJ1479407Medicaid
NJ15484310901Other982 BROAD STREET
NM1740345693Other741 BROADWAY