Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 38MC00692100 | NJ |
N | 111N00000X | Chiropractor | X012010-1 | NY |
N | 111NN0400X | Neurology | 38MC00692100 | NJ |
N | 111NN0400X | Neurology | X012010-1 | NY |
N | 111NS0005X | Chiropractic Sports Physician | 38MC00692100 | NJ |
NPI | 1902198427 |
---|---|
Provider Name | Dr. Michael Teytelbaum |
First Address | Fair Lawn, NJ 07410-1096 |
Second Address | Short Hills, NJ 07078-1437 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2011 |
Last Update Date | 03/05/2011 |