Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 25MA05620000 | NJ |
NPI | 1639276009 |
---|---|
Provider Name | Dr. Bruce Allen Edelman |
First Address | Tarrytown, NY 10591-5139 |
Second Address | East Brunswick, NJ 08816-5419 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 27/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4572408 | (05) | NJ |
E87652 | (02) | NJ |