Individual
JON H EDWARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
771 WEST END AVE, NEW YORK, NY 10025-5572
(216) 255-5700
(216) 255-5701
Mailing address
23625 COMMERCE PARK, SUITE 204, BEACHWOOD, OH 44122
(216) 255-5701
(216) 255-5701
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
130277
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00729680
—
NY
05
—
124078
—
AZ
05
—
2650215
—
OH
01
—
34195845144193
TRICARE WEST
—
05
—
7201480
—
SD
01
—
784T9
BCBS
NY
05
—
807444100
—
ID
01
—
P00285375
RXR MEDICARE
NY
Enumeration date
11/10/2005
Last updated
05/05/2014
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