Healthcare Provider Details

I. General information

NPI: 1619161171
Provider Name (Legal Business Name): ERENA TRESKOVA AND CO., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 08/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

682 E MAIN ST
MIDDLETOWN NY
10940-2646
US

IV. Provider business mailing address

22 GREAT HALL RD
MAHWAH NJ
07430-2593
US

V. Phone/Fax

Practice location:
  • Phone: 845-341-0264
  • Fax: 845-343-0962
Mailing address:
  • Phone: 201-679-4295
  • Fax: 201-444-4899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number202101
License Number StateNY

VIII. Authorized Official

Name: DR. ERENA TRESKOVA
Title or Position: MD
Credential: MD
Phone: 201-679-4295