Provider Demographics
NPI:1417191172
Name:TEPLITSKAYA, GALINA (AS)
Entity Type:Individual
Prefix:MRS
First Name:GALINA
Middle Name:
Last Name:TEPLITSKAYA
Suffix:
Gender:F
Credentials:AS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4315 12TH AVE
Mailing Address - Street 2:APT B-10
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-1348
Mailing Address - Country:US
Mailing Address - Phone:917-683-1839
Mailing Address - Fax:
Practice Address - Street 1:4315 12TH AVE
Practice Address - Street 2:APT B-10
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-1348
Practice Address - Country:US
Practice Address - Phone:917-683-1839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-26
Last Update Date:2009-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003560-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant