Provider Demographics
NPI:1962485458
Name:TESSLER, MARK JONATHAN (MD)
Entity Type:Individual
Prefix:MS
First Name:MARK
Middle Name:JONATHAN
Last Name:TESSLER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2500 SAINT RAYMONDS AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-3146
Mailing Address - Country:US
Mailing Address - Phone:718-904-1818
Mailing Address - Fax:718-904-9810
Practice Address - Street 1:2500 SAINT RAYMONDS AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3146
Practice Address - Country:US
Practice Address - Phone:718-904-1818
Practice Address - Fax:718-904-9810
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2010-07-27
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Provider Licenses
StateLicense IDTaxonomies
NY159272207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00954843Medicaid
NY00954843Medicaid
71D081Medicare ID - Type Unspecified