1578634358 NPI number — DR. EDWARD ARTHUR OLSEN EDWARD OLSEN

Table of content: DR. EDWARD ARTHUR OLSEN EDWARD OLSEN (NPI 1578634358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578634358 NPI number — DR. EDWARD ARTHUR OLSEN EDWARD OLSEN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLSEN
Provider First Name:
EDWARD
Provider Middle Name:
ARTHUR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
EDWARD OLSEN
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OLSEN
Provider Other First Name:
EDWARD
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
EDWARD OLSEN
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1578634358
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 MONMOUTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RED BANK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07701-1614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-842-7333
Provider Business Mailing Address Fax Number:
732-758-8118

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 MONMOUTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RED BANK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07701-1614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-842-7333
Provider Business Practice Location Address Fax Number:
732-758-8118
Provider Enumeration Date:
11/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  22DI01058600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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