Edwin J Custodio, APN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

26NJ15527500 Issued in NJ

Practice address

860 S White Horse Pike
Hammonton, NJ 08037-2018

Phone

(609) 567-0200

Fax

(609) 567-1951

NPI assigned

Apr 11, 2025

Last updated

Apr 28, 2026By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern Jersey Family Medical Centers, IncGroup PAC ID 0547170763, 42 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southern Jersey Family Medical Centers, Inc

  • Federally Qualified Health Center (FQHC)
  • Hammonton, NJ
  • NPI 1568473973
  Medicare reassignment Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1744329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777334400000",
    "number": "1174318844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "521 RICHARD DR",
            "city": "MILLVILLE",
            "state": "NJ",
            "postal_code": "083324040",
            "telephone_number": "856-285-0841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "860 S WHITE HORSE PIKE",
            "city": "HAMMONTON",
            "state": "NJ",
            "postal_code": "080372018",
            "telephone_number": "609-567-0200",
            "fax_number": "609-567-1951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUSTODIO",
        "first_name": "EDWIN",
        "middle_name": "J",
        "credential": "APN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-04-11",
        "last_updated": "2026-04-28",
        "certification_date": "2026-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NJ",
            "license": "26NJ15527500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew F Crescenzo, PT
• Cross Keys Family Eyecare Limited Liability Corporation
• Brandy Connie Crowther
• Jiayu Cui, PHARMD
• Abby Lynn Curnow, PHARMD
• Knesha L Cypress
• Nisrin Q Dahodwala, MD
• Debra Anne Dallett, PT
• Randi Dandy
• Bindu V Darji, PHARMD, RPH

• Family Nurse Practitioner in Hammonton, NJ
• Providers in Hammonton, NJ by specialty
• Family Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.