Provider Demographics
NPI:1699749150
Name:EDELSTEIN, JEFFREY PAUL (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:PAUL
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 1:2905 W WARNER RD
Mailing Address - Street 2:SUITE 20
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-1674
Mailing Address - Country:US
Mailing Address - Phone:480-962-9121
Mailing Address - Fax:480-655-7532
Practice Address - Street 1:2905 W WARNER RD
Practice Address - Street 2:SUITE 20
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-1674
Practice Address - Country:US
Practice Address - Phone:480-962-9121
Practice Address - Fax:480-655-7532
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ151002082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
D36795Medicare UPIN