Provider Demographics
NPI:1609513647
Name:EDELSON, LOREN FAITH (FNC, FNLP)
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:FAITH
Last Name:EDELSON
Suffix:
Gender:F
Credentials:FNC, FNLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 KINGS GATE RD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:NY
Mailing Address - Zip Code:10901-3110
Mailing Address - Country:US
Mailing Address - Phone:646-522-3511
Mailing Address - Fax:
Practice Address - Street 1:5 KINGS GATE RD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:NY
Practice Address - Zip Code:10901-3110
Practice Address - Country:US
Practice Address - Phone:646-522-3511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker