Provider Demographics
NPI:1023370343
Name:TETELBAUM, KATIA (SPECIAL ED)
Entity Type:Individual
Prefix:MS
First Name:KATIA
Middle Name:
Last Name:TETELBAUM
Suffix:
Gender:F
Credentials:SPECIAL ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6615 THORNTON PL
Mailing Address - Street 2:APT.5-F
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-5147
Mailing Address - Country:US
Mailing Address - Phone:917-754-5353
Mailing Address - Fax:
Practice Address - Street 1:6615 THORNTON PL
Practice Address - Street 2:APT.5-F
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-5147
Practice Address - Country:US
Practice Address - Phone:917-754-5353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1360761174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator