Active NPI
Teresa Min-Jung O, M.D.
- Otolaryngology Physician
- New York, NY
National Provider Identifier
1447308218
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- P39757
- Practice address
- 525 E 72ND St
Apt 25F
New York, NY 10021-9601 - Phone
- (646) 825-1893
- Fax
- (212) 249-1214
- NPI assigned
- Jan 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | P39757 | NY | Primary |
Addresses
Primary practice location
525 E 72ND St
Apt 25F
New York, NY 10021-9601
Mailing address
525 East 72ND Street
Apt 25F
New York, NY 10021-9601
Phone (646) 825-1893
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 17, 2020 through Apr 17, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P39757 | NY | MD | Otolaryngology Physician |
Interoperability endpoints
- to67561@northwell.direct-ci.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168214400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1186617600000",
"number": "1447308218",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "525 EAST 72ND STREET",
"address_2": "APT 25F",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100219601",
"telephone_number": "646-825-1893",
"fax_number": "212-249-1214"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "525 E 72ND ST",
"address_2": "APT 25F",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100219601",
"telephone_number": "646-825-1893",
"fax_number": "212-249-1214"
}
],
"practiceLocations": [],
"basic": {
"last_name": "O",
"first_name": "TERESA",
"middle_name": "MIN-JUNG",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-08",
"last_updated": "2007-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "NY",
"license": "P39757",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.