Individual
DYLAN EDELBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
120 MAIN ST, DANBURY, CT 06810-7834
(203) 743-9760
Mailing address
120 MAIN ST, DANBURY, CT 06810-7834
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
4703116404
MI
390200000X
Student in an Organized Health Care Education/Training Program
Primary
1.080399-RES
CT
Other
Enumeration date
05/05/2016
Last updated
04/09/2025
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