Provider Demographics
NPI:1790047314
Name:EDELSTEIN, REBECCA (MS)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:EDELSTEIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 BEACH 9TH ST
Mailing Address - Street 2:APARTMENT 4I
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5622
Mailing Address - Country:US
Mailing Address - Phone:516-303-6391
Mailing Address - Fax:
Practice Address - Street 1:146 BEACH 9TH ST
Practice Address - Street 2:APARTMENT 4I
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-5622
Practice Address - Country:US
Practice Address - Phone:516-303-6391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-10
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
NY58 023882235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist