Provider Demographics
NPI:1437473766
Name:EDELSTEIN, JILL SIMONE
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:SIMONE
Last Name:EDELSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 VETERANS RD W
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-2502
Mailing Address - Country:US
Mailing Address - Phone:718-701-6206
Mailing Address - Fax:718-701-6206
Practice Address - Street 1:2900 VETERANS RD W
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-2502
Practice Address - Country:US
Practice Address - Phone:718-701-6206
Practice Address - Fax:718-701-6206
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0541491183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0541491OtherNY RPH LICENSE NUMBER