Provider Demographics
NPI:1104922640
Name:TEPLER, IRA A (MD)
Entity type:Individual
Prefix:
First Name:IRA
Middle Name:A
Last Name:TEPLER
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 1:3333 HENRY HUDSON PKWY
Mailing Address - Street 2:WHITEHALL PROFESSIONAL CENTER STE 1
Mailing Address - City:RIVERDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10463
Mailing Address - Country:US
Mailing Address - Phone:718-796-1000
Mailing Address - Fax:718-796-2124
Practice Address - Street 1:3333 HENRY HUDSON PKWY
Practice Address - Street 2:STE 1
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463
Practice Address - Country:US
Practice Address - Phone:718-796-1000
Practice Address - Fax:718-796-2124
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193285207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01717757Medicaid
NY00N831Medicare ID - Type Unspecified
NY01717757Medicaid