Provider Demographics
NPI:1386803724
Name:DALE E. EDLIN, MD, LLC
Entity type:Organization
Organization Name:DALE E. EDLIN, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:E
Authorized Official - Last Name:EDLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-542-7600
Mailing Address - Street 1:179 AVENUE AT THE CMN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4804
Mailing Address - Country:US
Mailing Address - Phone:732-542-7600
Mailing Address - Fax:732-542-7655
Practice Address - Street 1:179 AVENUE AT THE CMN
Practice Address - Street 2:SUITE 101
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4804
Practice Address - Country:US
Practice Address - Phone:732-542-7600
Practice Address - Fax:732-542-7655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04064700207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty