1578754727 NPI number — DR. ELISABETH EDELSTEIN MD

Table of content: DR. ELISABETH EDELSTEIN MD (NPI 1578754727)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578754727 NPI number — DR. ELISABETH EDELSTEIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EDELSTEIN
Provider First Name:
ELISABETH
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TRIPODI
Provider Other First Name:
ELISABETH
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578754727
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
108 ALBRIGHT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YELLOWSTONE NATIONAL PARK
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82190
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 ALBRIGHT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YELLOWSTONE NATIONAL PARK
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82190
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-344-7965
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/05/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  MD431630 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: DR.0060124 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 12034C , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)