Provider Demographics
NPI:1447308218
Name:O, TERESA MIN-JUNG (MD)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:MIN-JUNG
Last Name:O
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 EAST 72ND STREET
Mailing Address - Street 2:APT 25F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-9601
Mailing Address - Country:US
Mailing Address - Phone:646-825-1893
Mailing Address - Fax:212-249-1214
Practice Address - Street 1:525 E 72ND ST
Practice Address - Street 2:APT 25F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-9601
Practice Address - Country:US
Practice Address - Phone:646-825-1893
Practice Address - Fax:212-249-1214
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP39757207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology