Provider Demographics
NPI:1952599102
Name:EDISON, NEIL HARVEY (MD)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:HARVEY
Last Name:EDISON
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 1:3107 STIRLING RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-6565
Mailing Address - Country:US
Mailing Address - Phone:954-986-1179
Mailing Address - Fax:954-986-1959
Practice Address - Street 1:3107 STIRLING RD
Practice Address - Street 2:SUITE 103
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-6565
Practice Address - Country:US
Practice Address - Phone:954-986-1179
Practice Address - Fax:954-986-1959
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00158272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003844OtherAVMED
FL91706Medicare PIN
FL003844OtherAVMED