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General NPI Number Information
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NPI Number | 1730515065
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Entity Type | Individual
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Provider Name | DR. NICOLE ANNE TEEHAN
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Gender | Female
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Dates
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Enumeration Date | 09/18/2013
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Last Update Date | 11/20/2018
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Provider Practice Location Address
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Address Line | 1 BROOKDALE PLAZA BROOKDALE UNIVERSITY HOSPITAL AND MEDICAL CENTER
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City | BROOKLYN
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State | NY
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Zip | 11212
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Country | US
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Telephone | 718-624-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 180 ATLANTIC AVE APT B208
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City | FARMINGDALE
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State | NY
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Zip | 11735-2779
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Country | US
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Telephone | 929-372-0527
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Fax |
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 1326082223
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License Number State | NY
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