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General NPI Number Information
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NPI Number | 1255668281
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Entity Type | Organization
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Legal Business Name | STUART R. EDELSON, M.D., P.C.
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Dates
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Enumeration Date | 11/12/2009
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Last Update Date | 11/12/2009
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Provider Practice Location Address
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Address Line | 510 E 86TH ST 1D
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City | NEW YORK
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State | NY
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Zip | 10028-7504
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Country | US
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Telephone | 212-861-0570
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Fax |
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Provider Business Mailing Address
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Address Line | 510 E 86TH ST 1D
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City | NEW YORK
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State | NY
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Zip | 10028-7504
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Country | US
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Telephone | 212-861-0570
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STUART ROY EDELSON
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Credential | M.D.
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Telephone | 212-861-0570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number | MD084582
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License Number State | NY
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