Provider Demographics
NPI:1740250117
Name:EDLIN, DALE E (MD)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:E
Last Name:EDLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:179 AVENUE AT THE CMN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4804
Mailing Address - Country:US
Mailing Address - Phone:732-542-7600
Mailing Address - Fax:732-542-7655
Practice Address - Street 1:179 AVENUE AT THE CMN
Practice Address - Street 2:SUITE 101
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4804
Practice Address - Country:US
Practice Address - Phone:732-542-7600
Practice Address - Fax:732-542-7655
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA04064700207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3247902Medicaid
NJC53324Medicare UPIN
NJ3247902Medicaid