Individual
DR. RICHARD EDWARD EDSTROM JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
926 S COUNTRY RD, BELLPORT, NY 11713-2512
(631) 286-6130
(631) 286-6130
Mailing address
926 S COUNTRY RD, BELLPORT, NY 11713-2512
(631) 286-6130
(631) 286-6130
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
170661
NY
Other
Enumeration date
08/04/2011
Last updated
08/04/2011
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