Individual
EDWARD A DIMITRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 SPRINGFIELD AVE, 3RD FLOOR, SUMMIT, NJ 07901-4055
(908) 934-0555
Mailing address
PO BOX 416457, BOSTON, MA 02241-6457
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
25MA06224300
NJ
207RP1001X
Pulmonary Disease Physician
MD042441L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
222233003
HORIZON BC
NJ
01
—
222233003035
CIGNA
NJ
01
—
290008483
RAILROAD MEDICARE
NJ
01
—
5043040
AETNA
NJ
01
—
77U432
EMPIRE HEALTH
NJ
01
—
CHN
1216963
NJ
01
—
P400548
OXFORD
NJ
Enumeration date
08/10/2005
Last updated
02/03/2017
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