Healthcare Provider Details

I. General information

NPI: 1003279019
Provider Name (Legal Business Name): YAKIRA TEITEL MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 CAMPUS RD
ANNANDALE ON HUDSON NY
12504-9800
US

IV. Provider business mailing address

30 CAMPUS RD
ANNANDALE ON HUDSON NY
12504-9800
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-1482
  • Fax:
Mailing address:
  • Phone: 845-758-7433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA151717
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number315402
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: