Provider Demographics
NPI:1740347202
Name:TEICH, MORTON MAX (MD)
Entity type:Individual
Prefix:DR
First Name:MORTON
Middle Name:MAX
Last Name:TEICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:930 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0209
Mailing Address - Country:US
Mailing Address - Phone:212-988-1821
Mailing Address - Fax:212-288-9289
Practice Address - Street 1:930 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0209
Practice Address - Country:US
Practice Address - Phone:212-988-1821
Practice Address - Fax:212-288-9289
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY97807207KA0200X, 2080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCO9984Medicare UPIN
NY444041Medicare ID - Type Unspecified