Provider Demographics
NPI:1730515065
Name:TEEHAN, NICOLE ANNE
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ANNE
Last Name:TEEHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 ATLANTIC AVE APT B208
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-2779
Mailing Address - Country:US
Mailing Address - Phone:929-372-0527
Mailing Address - Fax:
Practice Address - Street 1:1 BROOKDALE PLAZA
Practice Address - Street 2:BROOKDALE UNIVERSITY HOSPITAL AND MEDICAL CENTER
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212
Practice Address - Country:US
Practice Address - Phone:718-624-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY13260822231223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery