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General NPI Number Information
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NPI Number | 1700914033
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Entity Type | Organization
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Legal Business Name | NEW YORK CARDIOVASCULAR MEDICINE PLLC
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 04/03/2019
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Provider Practice Location Address
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Address Line | 65-36 99TH STREET
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City | REGO PARK
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State | NY
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Zip | 11374
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Country | US
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Telephone | 718-459-0700
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Fax |
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Provider Business Mailing Address
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Address Line | 6536 99TH ST
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City | REGO PARK
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State | NY
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Zip | 11374-4358
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Country | US
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Telephone | 718-459-0700
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Fax | 718-459-0705
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. DIMA TEITELMAN
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Credential | MD
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Telephone | 917-579-2343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 216625
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License Number State | NY
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