Provider Demographics
NPI:1043201734
Name:DEIERLEIN, THERESE (AUD)
Entity Type:Individual
Prefix:DR
First Name:THERESE
Middle Name:
Last Name:DEIERLEIN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 FORT LEE RD
Mailing Address - Street 2:STE #C, AUDIOLOGY 2000 INC
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3904
Mailing Address - Country:US
Mailing Address - Phone:212-628-2710
Mailing Address - Fax:212-628-3580
Practice Address - Street 1:34 E 67TH ST
Practice Address - Street 2:SUITE #4F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6119
Practice Address - Country:US
Practice Address - Phone:212-628-2710
Practice Address - Fax:212-628-3580
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0010601231H00000X
NJ41YA00028200231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4899742OtherGHI
P3163299OtherOXFORD
1000044420OtherAFFINITY HEALTH PLANS
3C5894OtherHEALTHNET
M73741OtherEMPIRE BC/BS
2394820OtherUNITED HEALTHCARE
6988043OtherCIGNA
4899742OtherGHI