Provider Demographics
NPI:1194712430
Name:GARRIDO, EDDY (MD)
Entity type:Individual
Prefix:
First Name:EDDY
Middle Name:
Last Name:GARRIDO
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 1:445 HURFFVILLE CROSSKEYS RD
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2337
Mailing Address - Country:US
Mailing Address - Phone:856-256-7591
Mailing Address - Fax:856-256-7585
Practice Address - Street 1:445 HURFFVILLE CROSSKEYS RD
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2337
Practice Address - Country:US
Practice Address - Phone:856-256-7591
Practice Address - Fax:856-256-7585
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019333E207T00000X
NJ25MA09749600207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000681404001Medicaid
PA000681404001Medicaid
PA000681404001Medicaid