Provider Demographics
NPI:1598786956
Name:TEITELBAUM, LOUIS K (MD, L FAPA)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:K
Last Name:TEITELBAUM
Suffix:
Gender:M
Credentials:MD, L FAPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 FRANKLIN AVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5801
Mailing Address - Country:US
Mailing Address - Phone:516-877-7832
Mailing Address - Fax:
Practice Address - Street 1:1 PANSMITH LN
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4724
Practice Address - Country:US
Practice Address - Phone:631-210-7300
Practice Address - Fax:516-877-2038
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1727442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01197740Medicaid
NYE50748Medicare UPIN
NY01197740Medicaid