Provider Demographics
NPI:1932260312
Name:EDSHTEYN, LYUDMILA (DO)
Entity Type:Individual
Prefix:MRS
First Name:LYUDMILA
Middle Name:
Last Name:EDSHTEYN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1284
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871
Mailing Address - Country:US
Mailing Address - Phone:201-694-9180
Mailing Address - Fax:
Practice Address - Street 1:65 N SUSSEX ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-3949
Practice Address - Country:US
Practice Address - Phone:973-361-5678
Practice Address - Fax:973-361-8312
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB072013208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
2262778OtherUNITED HEALTH CARE
4928514OtherCIGNA
P2781338OtherOXFORD
3013457OtherAETNA
2262778OtherUNITED HEALTH CARE
058357Medicare ID - Type Unspecified