1902991276 NPI number — ISIDORE TEPLER MD

Table of content: ISIDORE TEPLER MD (NPI 1902991276)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902991276 NPI number — ISIDORE TEPLER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TEPLER
Provider First Name:
ISIDORE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902991276
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
34 SHELBURNE ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STAMFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06902-3628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-327-6050
Provider Business Mailing Address Fax Number:
203-975-7342

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34 SHELBURNE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STAMFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06902-3628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-327-6050
Provider Business Practice Location Address Fax Number:
203-975-7342
Provider Enumeration Date:
10/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0000X , with the licence number:  034322 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: 034322 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RX0202X , with the licence number: 034322 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: C30942 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001343227 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 830003588 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".