Individual
EDGAR C ELUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1662 CENTRAL AVE, ALBANY, NY 12205
(518) 869-9692
(518) 869-7220
Mailing address
1662 CENTRAL AVE, ALBANY, NY 12205
(518) 869-9692
(518) 869-7220
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
111259
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000411153007
BLUE SHIELD OF NENY
—
01
—
000411153008
BLUE SHIELD OF NENY
—
01
—
10000574
CDPHP
—
01
—
115780
MVP
—
01
—
11742
MVP
—
01
—
141659448
STATEWIDE PPO
—
01
—
141752151
UNITED HEALTH CARE
—
01
—
24S111
BLUE CROSS BLUE SHIELD
—
01
—
24S112
BLUE CROSS BLUE SHIELD
—
01
—
24S113
BLUE CROSS BLUE SHIELD
—
01
—
2594608
GHI
—
01
—
4396748
AETNA
—
01
—
55333
GHI HMO
—
Enumeration date
12/27/2005
Last updated
09/28/2011
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