Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 149360 | NY |
NPI | 1063570083 |
---|---|
Provider Name | Dr. David R. Edelstein |
First Address | New York, NY 10028-1802 |
Second Address | New York, NY 10028-1802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 07/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B10738 | (02) | NY |