1730155987 NPI number — DR. GARY STEVEN EDELSTEIN O.D.

Table of content: THERESA LYNN LYONS FNP-C (NPI 1578734133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730155987 NPI number — DR. GARY STEVEN EDELSTEIN O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EDELSTEIN
Provider First Name:
GARY
Provider Middle Name:
STEVEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1730155987
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
38 W MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAPLE SHADE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08052-2432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-779-7595
Provider Business Mailing Address Fax Number:
856-779-7596

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
38 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAPLE SHADE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08052-2432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-779-7595
Provider Business Practice Location Address Fax Number:
856-779-7596
Provider Enumeration Date:
02/27/2006

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: 152W00000X , with the licence number:  27OA00499600 , 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)

  • Identifier: 3416405 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 35237 . This is a "DAVIS VISION" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 132507 . This is a "COLE VISION" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: NJ84996 . This is a "VISION BENEFITS AMERICA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 26010 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 26010 . This is a "SPECTERA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2K1495 . This is a "HEALTH NET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0604402 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5548003 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: NJ 4996 . This is a "EYEMED VISION" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 014929001 . This is a "MDCR DMERC" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0402335000 . This is a "AMERIHEALTH/KEYSTONE HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 580720 . This is a "BC/BS PA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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