Active NPI
Kenneth L Edelson, M.D.
- Procedural Dermatology Physician
- New York, NY
National Provider Identifier
1386616852
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Procedural Dermatology Physician
- License
- 116745
- Practice address
- 112 E 84TH St
#1B
New York, NY 10028-0901 - Phone
- (212) 744-4800
- Fax
- (212) 744-4808
- NPI assigned
- Feb 7, 2006
- Last updated
- Sep 11, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 116745 | NY | |
| Clinical & Laboratory Dermatological Immunology Physician | 207NI0002X | 116745 | NY | |
| Procedural Dermatology Physician | 207NS0135X | 116745 | NY | Primary |
Addresses
Primary practice location
112 E 84TH St
#1B
New York, NY 10028-0901
Mailing address
112 E 84TH St
#1B
New York, NY 10028-0901
Phone (212) 744-4800
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101208000521 | NY | Practitioner - Dermatology | 0648467217 | Practice locations: New York, NY |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 116745 | NY | MD | Social Worker |
Networks
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H3359
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139270400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1386616852",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "112 E 84TH ST",
"address_2": "#1B",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100280901",
"telephone_number": "212-744-4800",
"fax_number": "212-744-4808"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "112 E 84TH ST",
"address_2": "#1B",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100280901",
"telephone_number": "212-744-4800",
"fax_number": "212-744-4808"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDELSON",
"first_name": "KENNETH",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-02-07",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "NY",
"license": "116745",
"primary": false
},
{
"code": "207NI0002X",
"taxonomy_group": "",
"desc": "Dermatology, Clinical & Laboratory Dermatological Immunology",
"state": "NY",
"license": "116745",
"primary": false
},
{
"code": "207NS0135X",
"taxonomy_group": "",
"desc": "Dermatology, Procedural Dermatology",
"state": "NY",
"license": "116745",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.