Provider Demographics
NPI:1396011649
Name:EDELMAN, ELENA (OTR//L)
Entity Type:Individual
Prefix:MRS
First Name:ELENA
Middle Name:
Last Name:EDELMAN
Suffix:
Gender:F
Credentials:OTR//L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 WOOLEYS LN
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-2232
Mailing Address - Country:US
Mailing Address - Phone:516-482-2183
Mailing Address - Fax:
Practice Address - Street 1:10936 204TH ST
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-1326
Practice Address - Country:US
Practice Address - Phone:718-465-8310
Practice Address - Fax:718-465-3939
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012031225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist