Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 219892 | NY |
N | 207Q00000X | Family Doctor | 219892 | NY |
NPI | 1467402784 |
---|---|
Provider Name | Michael John Terzella |
First Address | Old Westbury, NY 11568-8000 |
Second Address | Old Westbury, NY 11568-8000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 04/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H71624 | (02) | NY |