Healthcare Provider Details

I. General information

NPI: 1295603561
Provider Name (Legal Business Name): CARREN TEITELBAUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2025
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S MADISON AVE
SPRING VALLEY NY
10977-5474
US

IV. Provider business mailing address

105 S MADISON AVE
SPRING VALLEY NY
10977-5474
US

V. Phone/Fax

Practice location:
  • Phone: 845-577-6049
  • Fax: 845-577-6059
Mailing address:
  • Phone: 845-577-6049
  • Fax: 845-577-6059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number342273
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: