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General NPI Number Information
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NPI Number | 1114927506
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Entity Type | Individual
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Provider Name | JOEL B EDELSTEIN D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 07/01/2021
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Provider Practice Location Address
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Address Line | 1144 E JEFFERSON ST
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City | PHOENIX
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State | AZ
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Zip | 85034-2224
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Country | US
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Telephone | 480-606-1011
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Fax |
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Provider Business Mailing Address
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Address Line | 6400 SHAFER CT STE 700
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City | ROSEMONT
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State | IL
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Zip | 60018-4989
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Country | US
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Telephone | 346-376-1702
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Fax | 224-532-2780
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number | 1705
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License Number State | AZ
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