Provider Demographics
NPI:1366516502
Name:TESSLER, SEYMOUR (MD)
Entity type:Individual
Prefix:DR
First Name:SEYMOUR
Middle Name:
Last Name:TESSLER
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 1:2625 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4552
Mailing Address - Country:US
Mailing Address - Phone:718-648-3723
Mailing Address - Fax:718-616-0915
Practice Address - Street 1:2625 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4552
Practice Address - Country:US
Practice Address - Phone:718-648-3723
Practice Address - Fax:718-616-0915
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140190207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01724258Medicaid
C08986Medicare UPIN
NY01724258Medicaid