Provider Demographics
NPI:1952339673
Name:EDELSCHICK, DONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:
Last Name:EDELSCHICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-1103
Mailing Address - Country:US
Mailing Address - Phone:845-354-0690
Mailing Address - Fax:845-364-0830
Practice Address - Street 1:6 CHARLES ST
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-1103
Practice Address - Country:US
Practice Address - Phone:845-354-0690
Practice Address - Fax:845-364-0830
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138457207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY138457Medicaid
NYB16664Medicare UPIN
NY57A121Medicare ID - Type Unspecified