Healthcare Provider Details

I. General information

NPI: 1639162647
Provider Name (Legal Business Name): SEYMOUR LEONARD EDELSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2382 E 13TH ST
BROOKLYN NY
11229-4306
US

IV. Provider business mailing address

2382 E 13TH ST
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 Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number118741
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: