Provider Demographics
NPI:1255379871
Name:TELLER, ANDREW S (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:S
Last Name:TELLER
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 1:35 PROSPECT PARK W
Mailing Address - Street 2:APT. 12 B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-2370
Mailing Address - Country:US
Mailing Address - Phone:718-622-5917
Mailing Address - Fax:
Practice Address - Street 1:35 PROSPECT PARK W
Practice Address - Street 2:APT. 12 B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-2370
Practice Address - Country:US
Practice Address - Phone:718-622-5917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY134974207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY134974OtherLICENSE NUMBER
NY134974OtherLICENSE NUMBER