Healthcare Provider Details

I. General information

NPI: 1205923893
Provider Name (Legal Business Name): JOANN A TITELIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 13TH ST PARK SLOPE FAMILY HEALTH CENTER
BROOKLYN NY
11215-4802
US

IV. Provider business mailing address

5800 3RD AVE MANAGED CARE DEPARTMENT
BROOKLYN NY
11220-3702
US

V. Phone/Fax

Practice location:
  • Phone: 718-832-5980
  • Fax: 718-630-7437
Mailing address:
  • Phone: 718-630-7477
  • Fax: 718-630-7437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number055364
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number239888
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: