Individual
EDWARD R. FOG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1925 PACIFIC AVE, ATLANTIC CITY, NJ 08401-6713
(609) 441-8127
Mailing address
307 S EVERGREEN AVE, WOODBURY, NJ 08096-2739
(856) 686-4300
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MB71314
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2090379000
AMERIHEALTH
NJ
01
—
30028085
KEYSTONE MERCY
NJ
01
—
60018857
HORIZON NJ HEALTH
NJ
05
—
8837708
—
NJ
Enumeration date
07/06/2006
Last updated
12/21/2007
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