Healthcare Provider Details

I. General information

NPI: 1669432829
Provider Name (Legal Business Name): MARC ZEV TESSLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 AVENUE I
BROOKLYN NY
11210-2830
US

IV. Provider business mailing address

2502 AVENUE I
BROOKLYN NY
11210-2830
US

V. Phone/Fax

Practice location:
  • Phone: 718-258-1400
  • Fax: 718-421-0628
Mailing address:
  • Phone: 718-258-1400
  • Fax: 718-421-0628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number237671
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number237671
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA10922400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: