Provider Demographics
NPI:1487648309
Name:ATIK, TEDDY L (MD)
Entity Type:Individual
Prefix:
First Name:TEDDY
Middle Name:L
Last Name:ATIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 INDUSTRIAL WAY W
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-2265
Mailing Address - Country:US
Mailing Address - Phone:732-542-4477
Mailing Address - Fax:732-935-0355
Practice Address - Street 1:2 INDUSTRIAL WAY W
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-2265
Practice Address - Country:US
Practice Address - Phone:732-542-4477
Practice Address - Fax:732-935-0355
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06943100207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7992505Medicaid
NJ7992505Medicaid
027982N6QMedicare ID - Type Unspecified