Provider Demographics
NPI:1306061049
Name:EDELSTEIN, JOEL K (MD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:K
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 1:101 WASHINGTON LN
Mailing Address - Street 2:SUITE G1
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3505
Mailing Address - Country:US
Mailing Address - Phone:215-576-5977
Mailing Address - Fax:
Practice Address - Street 1:101 WASHINGTON LN
Practice Address - Street 2:SUITE G1
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3505
Practice Address - Country:US
Practice Address - Phone:215-576-5977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019418E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA154423Medicare ID - Type Unspecified
PAE63961Medicare UPIN