Individual
ETANA D EDELMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
655 W 254TH ST, BRONX, NY 10471-1259
(201) 561-3149
Mailing address
1935 EASTCHESTER RD APT 5F, BRONX, NY 10461-2142
(201) 561-3149
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
024899-01
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
024899-01
STATE OF NY EDUCATION DEPARTMENT
NY
Enumeration date
10/07/2020
Last updated
10/07/2020
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