Provider Demographics
NPI:1912347287
Name:EDWARDS, DOREEN D (TR)
Entity Type:Individual
Prefix:MRS
First Name:DOREEN
Middle Name:D
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:TR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2643 LIBERTY RDG
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-4923
Mailing Address - Country:US
Mailing Address - Phone:845-591-2221
Mailing Address - Fax:
Practice Address - Street 1:2643 LIBERTY RDG
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-4923
Practice Address - Country:US
Practice Address - Phone:845-591-2221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18543253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY15627760OtherHIPHMO