Provider Demographics
NPI:1821272667
Name:DR. ALAN R. TEITELBAUM, PC
Entity Type:Organization
Organization Name:DR. ALAN R. TEITELBAUM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:TEITELBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:212-369-9494
Mailing Address - Street 1:315 E 86TH ST
Mailing Address - Street 2:SUITE 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:SUITE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0129640001Medicare NSC