Provider Demographics
NPI:1811045032
Name:IGLE, ED (MSW)
Entity type:Individual
Prefix:MR
First Name:ED
Middle Name:
Last Name:IGLE
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 665
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08362-0665
Mailing Address - Country:US
Mailing Address - Phone:856-696-7356
Mailing Address - Fax:856-293-5226
Practice Address - Street 1:727 E LANDIS AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-8005
Practice Address - Country:US
Practice Address - Phone:856-696-7356
Practice Address - Fax:856-293-5226
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC001864001041C0700X
NJ37FI00081500106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist