Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0002X | Hospice and Palliative Medicine | 1705 | AZ |
NPI | 1114927506 |
---|---|
Provider Name | Joel B Edelstein |
First Address | Rosemont, IL 60018-4989 |
Second Address | Phoenix, AZ 85034-2224 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 01/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110217771 | RAILROAD MEDICARE (01) | |
1705 | STATE LICENSE (01) | AZ |
227513 | (05) | AZ |
E39315 | (02) | AZ |