Provider Demographics
NPI:1215123922
Name:SOLOMON,EDWARD M M D P A ETAL PT
Entity type:Organization
Organization Name:SOLOMON,EDWARD M M D P A ETAL PT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BOYD
Authorized Official - Middle Name:H
Authorized Official - Last Name:SEIDENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-444-5898
Mailing Address - Street 1:85 SOUTH MAPLE AVE
Mailing Address - Street 2:SUITE #4
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-4561
Mailing Address - Country:US
Mailing Address - Phone:201-444-5898
Mailing Address - Fax:201-447-5775
Practice Address - Street 1:85 SOUTH MAPLE AVE
Practice Address - Street 2:SUITE #4
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-4561
Practice Address - Country:US
Practice Address - Phone:201-444-5898
Practice Address - Fax:201-447-5775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0613320001Medicare NSC