Provider Demographics
NPI:1518792894
Name:TEITELBAUM, CHONAH
Entity type:Individual
Prefix:
First Name:CHONAH
Middle Name:
Last Name:TEITELBAUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 DORSET RD
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-3314
Mailing Address - Country:US
Mailing Address - Phone:845-538-6040
Mailing Address - Fax:
Practice Address - Street 1:5 DORSET RD
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-3314
Practice Address - Country:US
Practice Address - Phone:845-538-6040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst