MEDICARE: MS. TAMARA TEYTELMAN P.A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	011741	NY

General Provider Information

NPI Number	:	1083801021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TAMARA TEYTELMAN P.A

Provider Business Mailing Address
First Line	:	2839 W 33RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-1540
Country	:	US
Telephone Number	:	718-946-0249
Fax Number	:

Provider Business Practice Location Address
First Line	:	2839 W 33RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-1540
Country	:	US
Telephone Number	:	646-415-3490
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2007
Last Update Date	:	01/10/2008

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