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1255679064 NPI number — JASON SCOTT TEITELBAUM MD

NPI Number: 1255679064
Health Care Provider/Practitioner: JASON SCOTT TEITELBAUM MD

Information about “1255679064” NPI (JASON SCOTT TEITELBAUM MD) exists in 1255679064 in HTML format HTML  |  1255679064 in plain Text format TXT  |  1255679064 in PDF (Portable Document Format) PDF  |  1255679064 in an XML format XML  formats.

NPI Number : 1255679064 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1255679064",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "TEITELBAUM",
    "FirstName": "JASON",
    "MiddleName": "SCOTT",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "9 ABERDEEN DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WEST NYACK",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "10994-1301",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "845-642-8345",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "20 YORK ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NEW HAVEN",
    "PracticeLocationAddressStateName": "CT",
    "PracticeLocationAddressPostalCode": "06510-3220",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "203-785-5253",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/29/2013",
    "LastUpdateDate": "03/07/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207R00000X",
          "TaxonomyName": "Internal Medicine Physician",
          "LicenseNumber": "AS3501233-M208",
          "LicenseNumberStateCode": "CT",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2085R0202X",
          "TaxonomyName": "Diagnostic Radiology Physician",
          "LicenseNumber": "056155",
          "LicenseNumberStateCode": "CT",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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