Individual provider Active NPI

Deborah Edelman

  • Student in an Organized Health Care Education/Training Program
  • Brooklyn, NY
National Provider Identifier
1396150876
Registry record updated Jul 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
450 Clarkson Ave
Suny Downstate
Brooklyn, NY 11203
Phone
(718) 270-2902
NPI assigned
Jun 24, 2014
Last updated
Jul 28, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NY Primary
Psychiatry Physician 2084P0800X 7056 GA

Addresses

Primary practice location

450 Clarkson Ave
Suny Downstate
Brooklyn, NY 11203

Mailing address

1120 15TH St
Augusta, GA 30912-0004

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211111000728 NY Practitioner - Psychiatry 1951790062 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MCCD Psychiatry Services PLLCGroup PAC ID 4082049036, 206 clinicians

Practice addresses (Care Compare)

109 W 27TH St
5S
New York, NY 10001-6208
Phone (833) 351-8255

926 Bedford Ave
Brooklyn, NY 11205-3913
Phone (718) 875-6900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
7056GAMDRegistered Respiratory Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
MCCD Psychiatry Services PLLC Psychiatry CurrentSince Feb 1, 2022 Accepting new patients
Pesach Tikvah Hope Development Inc CurrentSince Oct 5, 2024 Accepting new patients
Pesach Tikvah Hope Development Inc CurrentSince Oct 5, 2024 Accepting new patients

Locations

365 Willoughby Ave
Ste 400
Brooklyn, NY 11205

5309 18th Ave
Brooklyn, NY 11204
Phone (718) 705-5190

926 Bedford Ave
Brooklyn, NY 11205
Phone (718) 309-3044

109 W 27th St
#55
New York, NY 10001

109 W 27th St
Rm 5S
New York, NY 10001
Phone (332) 230-4572

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1403568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1501200000000",
    "number": "1396150876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 15TH ST",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309120004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 CLARKSON AVE",
            "address_2": "SUNY DOWNSTATE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11203",
            "telephone_number": "718-270-2902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDELMAN",
        "first_name": "DEBORAH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-24",
        "last_updated": "2017-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "GA",
            "license": "7056",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.