Provider Demographics
NPI:1477064152
Name:EDELSTEIN, AHUVA
Entity Type:Individual
Prefix:MRS
First Name:AHUVA
Middle Name:
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 1:29 WESTCOTT ST
Mailing Address - Street 2:
Mailing Address - City:INWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11096-1221
Mailing Address - Country:US
Mailing Address - Phone:917-697-0188
Mailing Address - Fax:
Practice Address - Street 1:29 WESTCOTT ST
Practice Address - Street 2:
Practice Address - City:INWOOD
Practice Address - State:NY
Practice Address - Zip Code:11096-1221
Practice Address - Country:US
Practice Address - Phone:917-697-0188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-20
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF382722-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics