Provider Demographics
NPI:1003954843
Name:EDELSTEIN, VICTORIA (DDS)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:
Last Name:EDELSTEIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2568 E 17TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3557
Mailing Address - Country:US
Mailing Address - Phone:212-297-0357
Mailing Address - Fax:718-891-0670
Practice Address - Street 1:2568 E 17TH ST STE 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3557
Practice Address - Country:US
Practice Address - Phone:212-297-0357
Practice Address - Fax:718-891-0670
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2022-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0454401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01524309Medicaid