=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003279019
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YAKIRA TEITEL MD, MPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2016
-----------------------------------------------------
Last Update Date | 10/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30 CAMPUS RD
-----------------------------------------------------
City | ANNANDALE ON HUDSON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12504-9800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-476-1482
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30 CAMPUS RD
-----------------------------------------------------
City | ANNANDALE ON HUDSON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12504-9800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-758-7433
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | A151717
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 315402
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------