Provider Demographics
NPI:1720075070
Name:HARBACK, EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:HARBACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 NORTHFIELD AVE
Mailing Address - Street 2:STE 205
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1174
Mailing Address - Country:US
Mailing Address - Phone:973-467-1544
Mailing Address - Fax:973-467-9586
Practice Address - Street 1:741 NORTHFIELD AVE
Practice Address - Street 2:STE 205
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1174
Practice Address - Country:US
Practice Address - Phone:973-467-1544
Practice Address - Fax:973-467-9586
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05031200207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
34E091OtherWELLCHOICE
2198907OtherGHI
6028624008OtherCIGNA
NJ5295602Medicaid
P1024454OtherOXFORD
90593OtherAMERIGROUP
1K9391OtherHEALTHNET
4507229OtherAETNA
010000348800OtherAMERICHOICE
0429576000OtherAMERIHEATLH
NJ606936A2BMedicare ID - Type Unspecified
2198907OtherGHI