Healthcare Provider Details

I. General information

NPI: 1811907710
Provider Name (Legal Business Name): STEVEN A TEICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 E 68TH ST GROUND FL - BOX P1
NEW YORK NY
10065-5844
US

IV. Provider business mailing address

20 E 68TH ST GROUND FL - BOX P1
NEW YORK NY
10065-5844
US

V. Phone/Fax

Practice location:
  • Phone: 212-734-9170
  • Fax: 212-734-9061
Mailing address:
  • Phone: 212-734-9170
  • Fax: 212-734-9061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number127558
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number127558
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: