Provider Demographics
NPI:1952049710
Name:TEPLOFF, DIMA
Entity Type:Individual
Prefix:
First Name:DIMA
Middle Name:
Last Name:TEPLOFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 8TH AVE UNIT 205
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-7800
Mailing Address - Country:US
Mailing Address - Phone:212-879-8888
Mailing Address - Fax:
Practice Address - Street 1:421 8TH AVE UNIT 205
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-7800
Practice Address - Country:US
Practice Address - Phone:212-879-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY457631163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator