Healthcare Provider Details

I. General information

NPI: 1568404283
Provider Name (Legal Business Name): ERENA TRESKOVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 12/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

682 E MAIN ST STE 2D
MIDDLETOWN NY
10940-2647
US

IV. Provider business mailing address

PO BOX 18666
BELFAST ME
04915-4081
US

V. Phone/Fax

Practice location:
  • Phone: 845-341-0264
  • Fax: 845-343-0962
Mailing address:
  • Phone: 845-341-0264
  • Fax: 845-343-0962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number25MA06362400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: