Provider Demographics
NPI:1558348730
Name:EDELMAN, ERIC E
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:E
Last Name:EDELMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 S BAY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-3627
Mailing Address - Country:US
Mailing Address - Phone:315-458-1777
Mailing Address - Fax:315-458-9661
Practice Address - Street 1:514 S BAY RD
Practice Address - Street 2:
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-3627
Practice Address - Country:US
Practice Address - Phone:315-458-1777
Practice Address - Fax:315-458-9661
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006040213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01780405Medicaid
NY0468700001Medicare NSC
NY01780405Medicaid
NYRA6375Medicare ID - Type Unspecified