Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 116745 | NY |
N | 207NS0135X | Procedural Dermatology | 116745 | NY |
NPI | 1386616852 |
---|---|
Provider Name | Dr. Kenneth L Edelson |
First Address | New York, NY 10028-0901 |
Second Address | New York, NY 10028-0901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B13421 | (02) |