Provider Demographics
NPI:1689620353
Name:TEICHER, MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:TEICHER
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 1:1030 CLIFTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013
Mailing Address - Country:US
Mailing Address - Phone:973-778-3777
Mailing Address - Fax:973-778-3252
Practice Address - Street 1:1030 CLIFTON AVENUE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013
Practice Address - Country:US
Practice Address - Phone:973-778-3777
Practice Address - Fax:973-778-3252
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA52697207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ405609WC0Medicare PIN
NJE60746Medicare UPIN
NJ222838862OtherTAX ID NUMBER
222838862OtherHORIZON BCBS
PS189OtherOXFORD
NJ405632Medicare PIN
436843OtherLIGRA
56104OtherAETNA
700928OtherHEALTHNET
NJ405609AYNMedicare PIN