Healthcare Provider Details

I. General information

NPI: 1962740092
Provider Name (Legal Business Name): MALCOLM GILBERT IDELSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2013
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 POND HILLS COURT
PLEASANT VALLEY NY
12569
US

IV. Provider business mailing address

30 POND HILLS COURT
PLEASANT VALLEY NY
12569
US

V. Phone/Fax

Practice location:
  • Phone: 845-635-9132
  • Fax: 845-635-1381
Mailing address:
  • Phone: 845-635-9132
  • Fax: 845-635-1381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number080056-1
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number080056-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: