Basic Information
Provider Information
NPI: 1003139437
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TEICH
FirstName: AARON
MiddleName: JASON
NamePrefix:  
NameSuffix:  
Credential: L.AC.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7 W 84TH ST
Address2: APT. 2
City: NEW YORK
State: NY
PostalCode: 100244738
CountryCode: US
TelephoneNumber: 9174457232
FaxNumber:  
Practice Location
Address1: 7 W 84TH ST
Address2: APT. 2
City: NEW YORK
State: NY
PostalCode: 100244738
CountryCode: US
TelephoneNumber: 9174457232
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/12/2010
LastUpdateDate: 03/12/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
171100000XAC12699CAN Other Service ProvidersAcupuncturist 
171100000X0042581NYY Other Service ProvidersAcupuncturist 

No ID Information.


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