Doctor Name: | DR. JASON D IDELSON |
NPI Number: | 1124287958 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.O |
License Number: | |
Business Practice Address: | 100 Port Washington Blvd. Dept. Of Emergency Medicine Roslyn, NY - 115761347 |
Business Phone Number: | 5165626605 |
Business Fax Number: | 5165626612 |
Mailing Address: | Pob 1470, PORT WASHINGTON |
State: | NY |
Postal Code: | 110501470 |
Phone Number: | 5166292454 |
Fax Number: | 5166292452 |
NPI Enumeration Date: | 06/06/2008 |
NPI Last Update Date: | 10/21/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |