Provider Demographics
NPI:1427795517
Name:EDELORBE LLC
Entity type:Organization
Organization Name:EDELORBE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEL ORBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-862-5215
Mailing Address - Street 1:603 W 148TH ST APT 9B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-3135
Mailing Address - Country:US
Mailing Address - Phone:347-930-0280
Mailing Address - Fax:718-347-4643
Practice Address - Street 1:116 E 124TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-1924
Practice Address - Country:US
Practice Address - Phone:646-979-3316
Practice Address - Fax:646-979-3320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05725402Medicaid