Healthcare Provider Details

I. General information

NPI: 1245390442
Provider Name (Legal Business Name): MARVIN L TEICH MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 THWAITES PL
BRONX NY
10467-7947
US

IV. Provider business mailing address

PO BOX 302
RYE NY
10580-0302
US

V. Phone/Fax

Practice location:
  • Phone: 718-882-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number096234
License Number StateNY

VIII. Authorized Official

Name: MARVIN L TEICH
Title or Position: SOLE PROPRIETOR
Credential:
Phone: 718-882-3500