Provider Demographics
NPI:1891731790
Name:SELF, EDWARD B JR (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:B
Last Name:SELF
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:385 S MAPLE AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-1543
Mailing Address - Country:US
Mailing Address - Phone:201-447-1188
Mailing Address - Fax:201-447-8935
Practice Address - Street 1:385 S MAPLE AVE
Practice Address - Street 2:STE 101
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07452-1543
Practice Address - Country:US
Practice Address - Phone:201-447-1188
Practice Address - Fax:201-447-8935
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2008-09-09
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Provider Licenses
StateLicense IDTaxonomies
NJMA33233207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD18650Medicare UPIN