Provider Demographics
NPI:1982911863
Name:TERESA O MD, PLLC
Entity Type:Organization
Organization Name:TERESA O MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:O
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-636-3977
Mailing Address - Street 1:126 W 60TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7402
Mailing Address - Country:US
Mailing Address - Phone:212-636-3977
Mailing Address - Fax:
Practice Address - Street 1:126 W 60TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7402
Practice Address - Country:US
Practice Address - Phone:212-636-3977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty