Provider Demographics
NPI:1477712354
Name:JONES, EDWIN O
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:O
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 SUMMIT AVE
Mailing Address - Street 2:APT 2D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-4621
Mailing Address - Country:US
Mailing Address - Phone:646-542-6298
Mailing Address - Fax:646-542-6298
Practice Address - Street 1:1249 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029
Practice Address - Country:US
Practice Address - Phone:212-360-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2731201207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine