Healthcare Provider Details

I. General information

NPI: 1306937347
Provider Name (Legal Business Name): JEFFREY L. TEITELBAUM, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 AVENUE L
BROOKLYN NY
11230-4707
US

IV. Provider business mailing address

913 AVENUE L
BROOKLYN NY
11230-4707
US

V. Phone/Fax

Practice location:
  • Phone: 718-859-8391
  • Fax:
Mailing address:
  • Phone: 718-859-8391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number188400
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number188400
License Number StateNY

VIII. Authorized Official

Name: MISS MALKY TENENBAUM
Title or Position: OFFICE MANAGER
Credential:
Phone: 718-859-8391