Healthcare Provider Details

I. General information

NPI: 1508156142
Provider Name (Legal Business Name): TERESA POLITO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2011
Last Update Date: 07/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 DAVIDSON AVE
BRONX NY
10468-6308
US

IV. Provider business mailing address

717 149TH ST
WHITESTONE NY
11357-1640
US

V. Phone/Fax

Practice location:
  • Phone: 718-933-4034
  • Fax:
Mailing address:
  • Phone: 718-746-5218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number262354
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: