John Benjamin Edwards

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

287268 Issued in NY

Practice address

3975 56TH St Apt 4B
Woodside, NY 11377-8900

Phone

(646) 627-4985

NPI assigned

Jan 26, 2021

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1611619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611619200000",
    "number": "1497345136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3975 56TH ST APT 4B",
            "city": "WOODSIDE",
            "state": "NY",
            "postal_code": "113778900",
            "telephone_number": "164-662-7498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3975 56TH ST APT 4B",
            "city": "WOODSIDE",
            "state": "NY",
            "postal_code": "113778900",
            "telephone_number": "646-627-4985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "JOHN",
        "middle_name": "BENJAMIN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-01-26",
        "last_updated": "2021-01-26",
        "certification_date": "2021-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NY",
            "license": "287268",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Woodside, NY
• Providers in Woodside, NY by specialty
• General Practice Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.