Healthcare Provider Details

I. General information

NPI: 1386260586
Provider Name (Legal Business Name): TERESA LANTIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1086 N BROADWAY STE 50
YONKERS NY
10701-1115
US

IV. Provider business mailing address

PO BOX 788
HARRISON NY
10528-0788
US

V. Phone/Fax

Practice location:
  • Phone: 914-391-1274
  • Fax:
Mailing address:
  • Phone: 914-391-1274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number203829
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: