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General NPI Number Information
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NPI Number | 1568404283
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Entity Type | Individual
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Provider Name | ERENA TRESKOVA MD
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Gender | Female
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 12/30/2016
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Provider Practice Location Address
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Address Line | 682 E MAIN ST STE 2D
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City | MIDDLETOWN
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State | NY
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Zip | 10940-2647
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Country | US
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Telephone | 845-341-0264
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Fax | 845-343-0962
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Provider Business Mailing Address
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Address Line | PO BOX 18666
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City | BELFAST
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State | ME
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Zip | 04915-4081
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Country | US
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Telephone | 845-341-0264
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Fax | 845-343-0962
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | 25MA06362400
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License Number State | NJ
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