Provider Demographics
NPI:1891007852
Name:PICKERING, EDWARD ALDEN (NP)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:ALDEN
Last Name:PICKERING
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5947 SUN LN # 125
Mailing Address - Street 2:
Mailing Address - City:MORAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:13118-4341
Mailing Address - Country:US
Mailing Address - Phone:315-497-3041
Mailing Address - Fax:
Practice Address - Street 1:5947 SUN LN # 125
Practice Address - Street 2:
Practice Address - City:MORAVIA
Practice Address - State:NY
Practice Address - Zip Code:13118-4341
Practice Address - Country:US
Practice Address - Phone:315-497-3041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340083363LG0600X, 364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology