MEDICARE: CHRISTOPHER EDELSTEIN RPA

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	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	007788-1	NY
2	363A00000X	Physician Assistant	007788	NY

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	:	1467472498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER EDELSTEIN RPA

Provider Business Mailing Address
First Line	:	201 MANOR PL
Second Line	:
City	:	GREENPORT
State	:	NY
Zip	:	11944-1222
Country	:	US
Telephone Number	:	631-477-5144
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 NICOLLS RD
Second Line	:
City	:	STONY BROOK
State	:	NY
Zip	:	11790-3407
Country	:	US
Telephone Number	:	631-444-1000
Fax Number	:

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	10/02/2018

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