Individual
EDWIN A. DEITCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
90 BERGEN ST, DOC 7100, NEWARK, NJ 07103-2425
(973) 972-2400
(973) 972-2988
Mailing address
30 BERGEN ST, ADMC 12 1205, NEWARK, NJ 07107-3000
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
25MA06045100
NJ
2086S0102X
Surgical Critical Care Physician
25MA06045100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6188508
—
NJ
Enumeration date
07/17/2006
Last updated
08/21/2009
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