Provider Demographics
NPI:1023202447
Name:EPSTEIN, EDWARD MACK (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:MACK
Last Name:EPSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:97 NEW DORP LANE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-3034
Mailing Address - Country:US
Mailing Address - Phone:718-876-6220
Mailing Address - Fax:718-876-5969
Practice Address - Street 1:470 SEAVIEW AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3401
Practice Address - Country:US
Practice Address - Phone:718-987-5940
Practice Address - Fax:718-667-9708
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY137043207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00955082Medicaid
NY00955082Medicaid
NY45D461Medicare Oscar/Certification
NYFE1088699OtherDEA