Healthcare Provider Details

I. General information

NPI: 1407234776
Provider Name (Legal Business Name): JUAN A TERRE M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 11/21/2022
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 TULANE AVE FL 4
NEW ORLEANS LA
70112-2600
US

IV. Provider business mailing address

1825 EASTCHESTER RD # 2S48
BRONX NY
10461-2301
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-6113
  • Fax:
Mailing address:
  • Phone: 718-904-3388
  • Fax: 718-904-3133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number281539
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number281539
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number330448
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: