Healthcare Provider Details

I. General information

NPI: 1508787961
Provider Name (Legal Business Name): NICOLE JEAN TEITEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

367 E 154TH ST
BRONX NY
10455-1191
US

IV. Provider business mailing address

131 W 25TH ST
NEW YORK NY
10001-7243
US

V. Phone/Fax

Practice location:
  • Phone: 212-803-5700
  • Fax:
Mailing address:
  • Phone: 212-803-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number408957
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: