Provider Demographics
NPI:1639162647
Name:EDELSTEIN, SEYMOUR LEONARD (MD)
Entity Type:Individual
Prefix:DR
First Name:SEYMOUR
Middle Name:LEONARD
Last Name:EDELSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2382 E 13TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4306
Mailing Address - Country:US
Mailing Address - Phone:718-646-8787
Mailing Address - Fax:718-646-0098
Practice Address - Street 1:2382 E 13TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4306
Practice Address - Country:US
Practice Address - Phone:718-646-8787
Practice Address - Fax:718-646-0098
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118741207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0007841OtherGHI
NY400000384OtherMEDICARE RAILROAD GBA
1066255000OtherU.S. DEPT. OF LABOR
NY118741-8BOtherWBC
NY00276435Medicaid
AE6101000OtherBNDD
NY118741-8BOtherWCB
NYKS584OtherOXFORD INSURANCE CO.
1066255000OtherU.S. DEPT. OF LABOR
NY118741-8BOtherWCB