Provider Demographics
NPI:1184165961
Name:EDELMAN, BRIDGET A (CPED, CFTS)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:A
Last Name:EDELMAN
Suffix:
Gender:F
Credentials:CPED, CFTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110-114 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045
Mailing Address - Country:US
Mailing Address - Phone:607-756-8831
Mailing Address - Fax:607-756-8888
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:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCPED3874224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist