Healthcare Provider Details

I. General information

NPI: 1184637662
Provider Name (Legal Business Name): P.A. TERRACIANO, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2241 ESPLANADE AVE
BRONX NY
10469-5405
US

IV. Provider business mailing address

2241 ESPLANADE AVE
BRONX NY
10469-5405
US

V. Phone/Fax

Practice location:
  • Phone: 718-654-7122
  • Fax:
Mailing address:
  • Phone: 718-654-7122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number91750
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number214528
License Number StateNY

VIII. Authorized Official

Name: DR. ANTHONY TERRACIANO
Title or Position: PHYSICIAN
Credential: MD
Phone: 718-654-7122