Provider Demographics
NPI:1053425140
Name:DILKS, EDWARD BRUNER (RRT)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:BRUNER
Last Name:DILKS
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 RICHARDS DR
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1120
Mailing Address - Country:US
Mailing Address - Phone:609-927-0424
Mailing Address - Fax:
Practice Address - Street 1:1015 RICHARDS DR
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1120
Practice Address - Country:US
Practice Address - Phone:609-927-0424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ43ZA00383100227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered