Provider Demographics
NPI:1518311307
Name:TETELMAN, EMILY JILL (DO, FACOG)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:JILL
Last Name:TETELMAN
Suffix:
Gender:F
Credentials:DO, FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 POST AVE
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-2201
Mailing Address - Country:US
Mailing Address - Phone:516-333-1444
Mailing Address - Fax:
Practice Address - Street 1:372 POST AVE
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-2201
Practice Address - Country:US
Practice Address - Phone:516-333-1444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY301559207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY301559OtherNYS MEDICAL LICENSE