Provider Demographics
NPI:1477573541
Name:NIEUWENHUIS, EDWARD RICHARD JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:RICHARD
Last Name:NIEUWENHUIS
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:350 FRANKLIN AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-1909
Mailing Address - Country:US
Mailing Address - Phone:201-891-4930
Mailing Address - Fax:201-891-4715
Practice Address - Street 1:350 FRANKLIN AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-1909
Practice Address - Country:US
Practice Address - Phone:201-891-4930
Practice Address - Fax:201-891-4715
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMD02125213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1477573541Medicare NSC
NJ6010120001Medicare NSC
NJ724497Medicare PIN