Provider Demographics
NPI:1013194539
Name:S.LEONARD EDELSTEIN
Entity Type:Organization
Organization Name:S.LEONARD EDELSTEIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLO PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SEYMOUR
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:EDELSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-646-8787
Mailing Address - Street 1:2382 E 13TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4306
Mailing Address - Country:US
Mailing Address - Phone:718-646-8787
Mailing Address - Fax:718-646-0098
Practice Address - Street 1:2382 E 13TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4306
Practice Address - Country:US
Practice Address - Phone:718-646-8787
Practice Address - Fax:718-646-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118741332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1081750001Medicare NSC