Provider Demographics
NPI:1669040663
Name:TEITELBAUM, MENACHEM MENDEL (MD)
Entity Type:Individual
Prefix:
First Name:MENACHEM
Middle Name:MENDEL
Last Name:TEITELBAUM
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:NYU LANGONE HOSPITAL-LONG ISLAND
Mailing Address - Street 2:222 STATION PLAZA, SUITE 509
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:222 STATION PLAZA, SUITE 509
Practice Address - Street 2:NYU LANGONE HOSPITAL-LONG ISLAND
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501
Practice Address - Country:US
Practice Address - Phone:516-663-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program