Provider Demographics
NPI:1912975996
Name:WYMER, EDWIN (DO)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:
Last Name:WYMER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 S. COOKS BRIDGE RD.
Mailing Address - Street 2:SUITE 2-21
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-2524
Mailing Address - Country:US
Mailing Address - Phone:732-987-5733
Mailing Address - Fax:
Practice Address - Street 1:27 S. COOKS BRIDGE RD.
Practice Address - Street 2:SUITE 2-21
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-2524
Practice Address - Country:US
Practice Address - Phone:732-987-5733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2019-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07492000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics