Provider Demographics
NPI:1124004866
Name:EDELSBERG, IRVING (OD)
Entity type:Individual
Prefix:DR
First Name:IRVING
Middle Name:
Last Name:EDELSBERG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3331 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-4554
Mailing Address - Country:US
Mailing Address - Phone:732-502-0071
Mailing Address - Fax:732-869-9266
Practice Address - Street 1:3331 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-4554
Practice Address - Country:US
Practice Address - Phone:732-502-0071
Practice Address - Fax:732-869-9266
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00342200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1129503Medicaid
NJ1129503Medicaid
NJ521602Medicare ID - Type Unspecified