Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 112885 | NY |
NPI | 1306222682 |
---|---|
Provider Name | Paul Jeffrey Edelson |
First Address | Brooklyn, NY 11215-3606 |
Second Address | Jamaica, NY 11430 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2015 |
Last Update Date | 10/08/2015 |