Healthcare Provider Details

I. General information

NPI: 1548285497
Provider Name (Legal Business Name): DIMA TEITELMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6860 AUSTIN ST STE 303
FOREST HILLS NY
11375-4223
US

IV. Provider business mailing address

6860 AUSTIN ST STE 302
FOREST HILLS NY
11375-4223
US

V. Phone/Fax

Practice location:
  • Phone: 718-459-0700
  • Fax: 646-619-4380
Mailing address:
  • Phone: 718-459-0700
  • Fax: 718-459-0705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number216625-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: