Provider Demographics
NPI:1548285497
Name:TEITELMAN, DIMA (MD)
Entity type:Individual
Prefix:DR
First Name:DIMA
Middle Name:
Last Name:TEITELMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6860 AUSTIN ST
Mailing Address - Street 2:STE 302
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4223
Mailing Address - Country:US
Mailing Address - Phone:718-459-0700
Mailing Address - Fax:718-459-0705
Practice Address - Street 1:6536 99TH ST
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4358
Practice Address - Country:US
Practice Address - Phone:718-459-0700
Practice Address - Fax:718-459-0705
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216625-01207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02588392Medicaid
NY02588392Medicaid
NY08242GMedicare PIN