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NPI Code Detail

MEDICARE: TEDDY DAVID

MEDICARE: TEDDY DAVID
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1154707933
Entity Type Code : Individual
Provider Name (Legal Business Name) : TEDDY DAVID
Provider Business Mailing Address
First Line : 2488 GRAND CONCOURSE RM 417
Second Line :
City : BRONX
State : NY
Zip : 10458-5206
Country : US
Telephone Number : 718-584-7204
Fax Number : 718-584-8394
Provider Business Practice Location Address
First Line : 2488 GRAND CONCOURSE RM 417
Second Line :
City : BRONX
State : NY
Zip : 10458-5206
Country : US
Telephone Number : 718-584-7204
Fax Number : 718-584-8394
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2015
Last Update Date : 08/04/2015

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Directions to “ TEDDY DAVID ” Practice Location

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