Eddie Benjamin Davis III

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Practice address

1966 Melvina Rd
Woodbury, NJ 08096-5613

Phone

(856) 693-4446

NPI assigned

Jan 24, 2020

Last updated

Jan 28, 2020By 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1579824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580169600000",
    "number": "1699305086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1966 MELVINA RD",
            "city": "WOODBURY",
            "state": "NJ",
            "postal_code": "080965613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1966 MELVINA RD",
            "city": "WOODBURY",
            "state": "NJ",
            "postal_code": "080965613",
            "telephone_number": "856-693-4446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "EDDIE",
        "middle_name": "BENJAMIN",
        "name_suffix": "III",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-01-24",
        "last_updated": "2020-01-28",
        "certification_date": "2020-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Van Dautruche
• David D Carrozzino DPM, PC
• David Gehring M.D.
• Stanley David, D.P.M.
• Wendy Faith David, DPM
• Michael J Davis, D.O. ANESTHESIOLOGIS
• Brenna Dean, PA-C
• Akilah Debeau, LMFT
• Kelsey Decker, M.ED., BCBA
• Dedicated Home Care,LLC

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Woodbury, NJ
• Providers in Woodbury, NJ by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2020; 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.