Individual
JONATHAN EDELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
123 GROVE AVE STE 200, CEDARHURST, NY 11516-2302
(718) 869-0869
Mailing address
123 GROVE AVE, CEDARHURST, NY 11516-2322
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
001205
NY
Other
Enumeration date
06/23/2020
Last updated
06/23/2020
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