Healthcare Provider Details

I. General information

NPI: 1942592134
Provider Name (Legal Business Name): JAIME EDELSTEIN RIVERA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAIME EDELSTEIN

II. Dates (important events)

Enumeration Date: 05/06/2011
Last Update Date: 04/23/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WEST ST PT AFFILIATED WITH HSS - 10TH FL
NEW YORK NY
10282-2102
US

IV. Provider business mailing address

535 E 70TH ST HOSP FOR SPECIAL SURGERY - REHAB DEPT
NEW YORK NY
10021-4823
US

V. Phone/Fax

Practice location:
  • Phone: 917-343-9887
  • Fax:
Mailing address:
  • Phone: 917-343-9887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number021117
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: