=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447347075
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIC SCOTT TEITEL MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2006
-----------------------------------------------------
Last Update Date | 12/08/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1985 CROMPOND RD UPPR E
-----------------------------------------------------
City | CORTLANDT MANOR
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10567-4146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-734-8224
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1985 CROMPOND RD UPPR E
-----------------------------------------------------
City | CORTLANDT MANOR
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10567-4146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-734-8224
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 025787
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 42477
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 142956-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------