Basic Information
| Provider Information | |||||||||
| NPI: | 1487208914 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EDELSTEIN | ||||||||
| FirstName: | MARLENE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 51 PERKINS ST | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065133210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6465524136 | ||||||||
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| Practice Location | |||||||||
| Address1: | 134 STATE ST | ||||||||
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| City: | MERIDEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064503293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032372229 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2019 | ||||||||
| LastUpdateDate: | 08/01/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 8367 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.