Provider Demographics
NPI:1700073939
Name:PAUL C TEODORO MD INC
Entity Type:Organization
Organization Name:PAUL C TEODORO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:C
Authorized Official - Last Name:TEODORO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-798-1200
Mailing Address - Street 1:422 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-2727
Mailing Address - Country:US
Mailing Address - Phone:201-798-1200
Mailing Address - Fax:
Practice Address - Street 1:422 GRAND ST
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-2727
Practice Address - Country:US
Practice Address - Phone:201-798-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA04849800261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
E40259Medicare UPIN
NJ089641Medicare PIN