Healthcare Provider Details

I. General information

NPI: 1609846468
Provider Name (Legal Business Name): ALAN R TEITELBAUM DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E 86TH ST 1GE
NEW YORK NY
10028-4714
US

IV. Provider business mailing address

315 E 86TH ST 1GE
NEW YORK NY
10028-4714
US

V. Phone/Fax

Practice location:
  • Phone: 212-369-9494
  • Fax: 212-369-9488
Mailing address:
  • Phone: 212-369-9494
  • Fax: 212-369-9488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberN002880
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: