MEDICARE: DINA EDELSHTEYN

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	247200000X	Other Technician

General Provider Information

NPI Number	:	1942575840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DINA EDELSHTEYN

Provider Business Mailing Address
First Line	:	6410 VETERANS AVE
Second Line	:	STE 202
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5605
Country	:	US
Telephone Number	:	347-462-2780
Fax Number	:

Provider Business Practice Location Address
First Line	:	6410 VETERANS AVE
Second Line	:	STE 202
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5605
Country	:	US
Telephone Number	:	347-462-2780
Fax Number	:

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

Provider Enumeration Date	:	03/12/2012
Last Update Date	:	03/12/2012

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