Provider Demographics
NPI:1831154475
Name:TEITELBAUM, JONATHAN E (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:E
Last Name:TEITELBAUM
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8000
Mailing Address - Street 2:DEPT 596
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14267-0002
Mailing Address - Country:US
Mailing Address - Phone:866-295-0041
Mailing Address - Fax:708-342-2517
Practice Address - Street 1:279 3RD AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-6211
Practice Address - Country:US
Practice Address - Phone:732-923-6080
Practice Address - Fax:732-923-6083
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2013-02-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA069033002080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7927401Medicaid
NJ7927401Medicaid
NJ036917Medicare PIN