Provider Demographics
NPI:1710295043
Name:DEMARCO, EDWARD (CAC)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
Last Name:DEMARCO
Suffix:
Gender:M
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 MONMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:MONROE TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-8528
Mailing Address - Country:US
Mailing Address - Phone:732-251-0850
Mailing Address - Fax:
Practice Address - Street 1:139 MONMOUTH RD
Practice Address - Street 2:
Practice Address - City:MONROE TWP
Practice Address - State:NJ
Practice Address - Zip Code:08831-8528
Practice Address - Country:US
Practice Address - Phone:732-251-0850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00037400171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist