Provider Demographics
NPI:1174670152
Name:EDWARDS, JOSEPH S (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:S
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4422 3RD AVE
Mailing Address - Street 2:DEPT OF SURGERY
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-2545
Mailing Address - Country:US
Mailing Address - Phone:718-960-6127
Mailing Address - Fax:718-960-6132
Practice Address - Street 1:2016 BRONXDALE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-3388
Practice Address - Country:US
Practice Address - Phone:718-863-8695
Practice Address - Fax:718-863-5147
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY153953208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00846557Medicaid
NY231280OtherWORKERS COMPENSATION
NYP2631535OtherOXFORD
NY26D801OtherEMPIRE BLUE CROSS BLUE SH
NY27973POtherHIP
NY0198999OtherGHI
NY56516OtherAETNA-US HEALTHCARE
NY26D803OtherEMPIRE BLUE CROSS
NY27973POtherHIP
NYA61662Medicare UPIN