MEDICARE: MICHAEL CHARLES EDELSTEIN DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	N005269	NY
2	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376546853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL CHARLES EDELSTEIN DPM

Provider Business Mailing Address
First Line	:	3 WICKS DR
Second Line	:
City	:	COMMACK
State	:	NY
Zip	:	11725-3921
Country	:	US
Telephone Number	:	718-561-0041
Fax Number	:	718-561-0188

Provider Business Practice Location Address
First Line	:	3224 GRAND CONCOURSE, SUITE #BA
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458
Country	:	US
Telephone Number	:	718-561-0041
Fax Number	:	718-561-0188

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	02/17/2009

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