Provider Demographics
NPI:1326550682
Name:EDELSTEIN, ROBIN (OTR/L)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:EDELSTEIN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:LEINER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:122 STRATFORD PL
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-1467
Mailing Address - Country:US
Mailing Address - Phone:718-354-9389
Mailing Address - Fax:
Practice Address - Street 1:3391 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-2025
Practice Address - Country:US
Practice Address - Phone:718-608-9170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist