Provider Demographics
NPI:1114003993
Name:BELLER, EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:BELLER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 MEDFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-1221
Mailing Address - Country:US
Mailing Address - Phone:631-654-2929
Mailing Address - Fax:631-654-0217
Practice Address - Street 1:268 MEDFORD AVE
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1221
Practice Address - Country:US
Practice Address - Phone:631-654-2929
Practice Address - Fax:631-654-0217
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX1983111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT51943Medicare UPIN
NYX12031Medicare ID - Type Unspecified