MEDICARE: DR. ARI EDELSTEIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	125875	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558371591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARI EDELSTEIN MD

Provider Business Mailing Address
First Line	:	12510 QUEENS BLVD
Second Line	:	SUITE 322
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-1519
Country	:	US
Telephone Number	:	718-263-5252
Fax Number	:	718-544-5938

Provider Business Practice Location Address
First Line	:	12510 QUEENS BLVD
Second Line	:	SUITE 322
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-1519
Country	:	US
Telephone Number	:	718-263-5252
Fax Number	:	718-544-5938

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	07/08/2007

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