Provider Demographics
NPI:1265752471
Name:EDEL, WILLIAM ALTON (RN)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ALTON
Last Name:EDEL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DARK HOLLOW RD
Mailing Address - Street 2:APT. 4A
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2049
Mailing Address - Country:US
Mailing Address - Phone:631-828-5399
Mailing Address - Fax:
Practice Address - Street 1:1 DARK HOLLOW RD
Practice Address - Street 2:APT. 4A
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2049
Practice Address - Country:US
Practice Address - Phone:631-828-5399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22 498001163W00000X
SCR 102307163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse