Provider Demographics
NPI:1073805925
Name:MELVIN TEPLER MD PC
Entity Type:Organization
Organization Name:MELVIN TEPLER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TEPLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:171-867-7600
Mailing Address - Street 1:1252 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-5108
Mailing Address - Country:US
Mailing Address - Phone:718-677-6000
Mailing Address - Fax:718-677-7936
Practice Address - Street 1:1252 E 9TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5108
Practice Address - Country:US
Practice Address - Phone:718-677-6000
Practice Address - Fax:718-677-7936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00894179Medicaid
NYB16483Medicare UPIN
NY00894179Medicaid