Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | N002880 | NY |
NPI | 1609846468 |
---|---|
Provider Name | Dr. Alan R Teitelbaum |
First Address | New York, NY 10028-4714 |
Second Address | New York, NY 10028-4714 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 02/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1004246 | (05) | NY |
T50878 | (02) | NY |