Healthcare Provider Details

I. General information

NPI: 1568440485
Provider Name (Legal Business Name): DAVID G EDELSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOLLOW LN STE 109
NEW HYDE PARK NY
11042-1215
US

IV. Provider business mailing address

1 HOLLOW LN STE 109
NEW HYDE PARK NY
11042-1215
US

V. Phone/Fax

Practice location:
  • Phone: 516-627-4433
  • Fax: 516-627-0552
Mailing address:
  • Phone: 516-627-4433
  • Fax: 516-627-0552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number15517801
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: