Provider Demographics
NPI:1063570083
Name:EDELSTEIN, DAVID R (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:EDELSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 3RD AVE
Mailing Address - Street 2:4TH FLR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-1802
Mailing Address - Country:US
Mailing Address - Phone:212-452-1500
Mailing Address - Fax:212-472-3086
Practice Address - Street 1:1421 3RD AVE
Practice Address - Street 2:4TH FLR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-1802
Practice Address - Country:US
Practice Address - Phone:212-452-1500
Practice Address - Fax:212-472-3086
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149360207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY19D131Medicare PIN
NYB10738Medicare UPIN