Individual provider Active NPI

James F Edelstein, D.M.D.

  • Dentist
  • Wynnewood, PA
National Provider Identifier
1114361680
Registry record updated Apr 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DS022004L Issued in PA
Practice address
936 Clover Hill Rd
Wynnewood, PA 19096-1631
Phone
(610) 649-1255
NPI assigned
Apr 26, 2013
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 26, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DS022004L PA Primary

Addresses

Primary practice location

936 Clover Hill Rd
Wynnewood, PA 19096-1631

Mailing address

936 Clover Hill Rd
Wynnewood, PA 19096-1631

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160418002069 PA Order and Referring Only - Other (Physician)Practitioner - Other (Physician) 4789982125

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DS022004LPAMDDentist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1366934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366934400000",
    "number": "1114361680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "936 CLOVER HILL RD",
            "city": "WYNNEWOOD",
            "state": "PA",
            "postal_code": "190961631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "936 CLOVER HILL RD",
            "city": "WYNNEWOOD",
            "state": "PA",
            "postal_code": "190961631",
            "telephone_number": "610-649-1255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDELSTEIN",
        "first_name": "JAMES",
        "middle_name": "F",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-04-26",
        "last_updated": "2013-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS022004L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wynnewood, PA

Sources for this page

Verify at the official NPI Registry.