Provider Demographics
NPI:1255548731
Name:TETELMAN, MAUREEN ROSE (MS, LAC)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:ROSE
Last Name:TETELMAN
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 2ND AVE
Mailing Address - Street 2:APT 25G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-3911
Mailing Address - Country:US
Mailing Address - Phone:212-228-6687
Mailing Address - Fax:
Practice Address - Street 1:40 E 23RD ST
Practice Address - Street 2:3RD FL. AT KINESPIRIT STUDIO
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4400
Practice Address - Country:US
Practice Address - Phone:212-228-6687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002815171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist