Provider Demographics
NPI:1154419687
Name:TELLECHEA, NATASHA A (MD)
Entity type:Individual
Prefix:DR
First Name:NATASHA
Middle Name:A
Last Name:TELLECHEA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:68 S SERVICE RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2354
Mailing Address - Country:US
Mailing Address - Phone:516-945-3000
Mailing Address - Fax:516-945-3131
Practice Address - Street 1:380 N BROADWAY
Practice Address - Street 2:SUITE L2
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2109
Practice Address - Country:US
Practice Address - Phone:516-931-1776
Practice Address - Fax:516-942-1940
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2009-11-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY212694208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01927324Medicaid
NY2C0540OtherHEALTH NET
NY2H7541OtherEMPIRE BC/BS
NY2699157OtherGHI
NY5228760OtherAETNA
NYP1842678OtherOXFORD