Provider Demographics
NPI:1730476151
Name:TELETEN, NIKOLAY (MD)
Entity Type:Individual
Prefix:
First Name:NIKOLAY
Middle Name:
Last Name:TELETEN
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 1:101 SAINT ANDREWS LN
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2254
Mailing Address - Country:US
Mailing Address - Phone:516-674-7631
Mailing Address - Fax:516-674-7639
Practice Address - Street 1:101 SAINT ANDREWS LN
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2254
Practice Address - Country:US
Practice Address - Phone:516-674-7631
Practice Address - Fax:516-674-7639
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY276094207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine