Healthcare Provider Details

I. General information

NPI: 1639276009
Provider Name (Legal Business Name): BRUCE ALLEN EDELMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 CRANBURY RD STE 3
EAST BRUNSWICK NJ
08816-5419
US

IV. Provider business mailing address

660 WHITE PLAINS RD FL 4
TARRYTOWN NY
10591-5139
US

V. Phone/Fax

Practice location:
  • Phone: 732-238-0300
  • Fax: 732-238-4066
Mailing address:
  • Phone: 914-984-2546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number25MA05620000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: