Individual
FASIKA M TEDLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5 E 98TH ST FL 12, NEW YORK, NY 10029-6501
(212) 659-8086
(212) 731-7220
Mailing address
1 GUSTAVE L LEVY PL # 1104, NEW YORK, NY 10029-6504
(212) 659-8086
(212) 731-7220
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
222336
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02668537
—
NY
Enumeration date
07/29/2005
Last updated
11/07/2019
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