Provider Demographics
NPI:1699772236
Name:GROSS-EDWARDS, JENNIFER J (DPM)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:GROSS-EDWARDS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1356 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18067-1798
Mailing Address - Country:US
Mailing Address - Phone:610-262-3417
Mailing Address - Fax:610-262-1404
Practice Address - Street 1:1356 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18067-1798
Practice Address - Country:US
Practice Address - Phone:610-262-3417
Practice Address - Fax:610-262-1404
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004802L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101757395-0003Medicaid
PA5909150001Medicare NSC
PA068594WDHMedicare PIN
PA101757395-0003Medicaid