Healthcare Provider Details

I. General information

NPI: 1114162146
Provider Name (Legal Business Name): DAVID M. EDELSTEIN, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2008
Last Update Date: 12/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2382 EAST 13 STREET
BROOKLYN NY
11229-4306
US

IV. Provider business mailing address

2382 EAST 13 STREET
BROOKLYN NY
11229-4306
US

V. Phone/Fax

Practice location:
  • Phone: 718-646-8787
  • Fax: 718-646-0098
Mailing address:
  • Phone: 718-646-8787
  • Fax: 718-646-0098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number237998
License Number StateNY

VIII. Authorized Official

Name: DAVID MARC EDELSTEIN
Title or Position: OWNER
Credential: MD, PC
Phone: 718-646-8787