Provider Demographics
NPI:1609846468
Name:TEITELBAUM, ALAN R (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:R
Last Name:TEITELBAUM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 E 86TH ST
Mailing Address - Street 2:1GE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-4714
Mailing Address - Country:US
Mailing Address - Phone:212-369-9494
Mailing Address - Fax:212-369-9488
Practice Address - Street 1:315 E 86TH ST
Practice Address - Street 2:1GE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-4714
Practice Address - Country:US
Practice Address - Phone:212-369-9494
Practice Address - Fax:212-369-9488
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002880213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1004246Medicaid
NYT50878Medicare UPIN
NYP31132Medicare ID - Type Unspecified
NY0129640001Medicare NSC