=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265502736
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOEL LEWIS TEICHER M.D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2006
-----------------------------------------------------
Last Update Date | 03/18/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 BROOKDALE PLZ SUITE 145
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11212-3139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-240-5441
-----------------------------------------------------
Fax | 718-240-6745
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 360051
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11236-0051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-240-5441
-----------------------------------------------------
Fax | 718-240-6745
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 086347
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------