Provider Demographics
NPI:1093962664
Name:TEPPER, BRIAN J (MPS, ATR-BC, LCAT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:J
Last Name:TEPPER
Suffix:
Gender:M
Credentials:MPS, ATR-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 FRANKLIN TPKE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-1932
Mailing Address - Country:US
Mailing Address - Phone:917-751-7184
Mailing Address - Fax:
Practice Address - Street 1:156 5TH AVE STE 916
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7760
Practice Address - Country:US
Practice Address - Phone:917-751-7184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000025174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist