Provider Demographics
NPI:1942585948
Name:TERESH, MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:TERESH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:69 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2114
Mailing Address - Country:US
Mailing Address - Phone:732-409-3633
Mailing Address - Fax:731-409-7133
Practice Address - Street 1:470 STILLWELLS CORNER RD
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2969
Practice Address - Country:US
Practice Address - Phone:732-780-3333
Practice Address - Fax:732-780-6968
Is Sole Proprietor?:No
Enumeration Date:2011-10-21
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA09013100208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics