Provider Demographics
NPI:1053829770
Name:STEWART G EIDELSON MD PLLC
Entity Type:Organization
Organization Name:STEWART G EIDELSON MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:G
Authorized Official - Last Name:EIDELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-742-5959
Mailing Address - Street 1:15300 S JOG RD STE 107-109
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-2162
Mailing Address - Country:US
Mailing Address - Phone:561-742-5959
Mailing Address - Fax:561-734-2226
Practice Address - Street 1:911 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0385
Practice Address - Country:US
Practice Address - Phone:212-288-7193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138890207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty