Provider Demographics
NPI:1720435605
Name:THEOSMY, EDWIN GREGORY (DO)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:GREGORY
Last Name:THEOSMY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 MAY ST STE 202
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3267
Mailing Address - Country:US
Mailing Address - Phone:908-757-1520
Mailing Address - Fax:
Practice Address - Street 1:205 MAY ST STE 202
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3267
Practice Address - Country:US
Practice Address - Phone:908-757-1520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB11413200207X00000X, 207XS0114X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program