Provider Demographics
NPI:1306222682
Name:EDELSON, PAUL JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:JEFFREY
Last Name:EDELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:455 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3606
Mailing Address - Country:US
Mailing Address - Phone:718-553-1685
Mailing Address - Fax:718-553-1524
Practice Address - Street 1:JFK INTL AIRPORT-TERMINAL4, RM.219.016
Practice Address - Street 2:CDC QUARANTINE STATION
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11430
Practice Address - Country:US
Practice Address - Phone:718-553-1685
Practice Address - Fax:718-553-1524
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1128852080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases