MEDICARE: MARVIN L TEICH MD

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	173000000X	Legal Medicine	096234	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245390442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARVIN L TEICH MD

Provider Business Mailing Address
First Line	:	PO BOX 302
Second Line	:
City	:	RYE
State	:	NY
Zip	:	10580-0302
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	665 THWAITES PL
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-7947
Country	:	US
Telephone Number	:	718-882-3500
Fax Number	:

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	MARVIN L TEICH
Credential	:
Telephone Number	:	718-882-3500

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	08/22/2020

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