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General NPI Number Information
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NPI Number | 1811637093
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Entity Type | Individual
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Provider Name | MIKKO ANGELO TESALONA MD
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Gender | Male
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Dates
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Enumeration Date | 03/29/2022
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 95 N STATE RT 17 STE 105
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City | PARAMUS
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State | NJ
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Zip | 07652-2648
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Country | US
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Telephone | 201-612-4737
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Fax | 201-689-6009
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Provider Business Mailing Address
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Address Line | 2319 3RD AVE APT 1023
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City | NEW YORK
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State | NY
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Zip | 10035-1879
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Country | US
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Telephone | 516-697-7863
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25MA12736500
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License Number State | NJ
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