Healthcare Provider Details

I. General information

NPI: 1376546853
Provider Name (Legal Business Name): MICHAEL CHARLES EDELSTEIN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 02/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3224 GRAND CONCOURSE, SUITE #BA
BRONX NY
10458
US

IV. Provider business mailing address

3 WICKS DR
COMMACK NY
11725-3921
US

V. Phone/Fax

Practice location:
  • Phone: 718-561-0041
  • Fax: 718-561-0188
Mailing address:
  • Phone: 718-561-0041
  • Fax: 718-561-0188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN005269
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: