Healthcare Provider Details

I. General information

NPI: 1609175876
Provider Name (Legal Business Name): ANNA TERAJEWICZ LAROSE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNA TERAJEWICZ MD

II. Dates (important events)

Enumeration Date: 03/27/2011
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 DELAWARE AVE
DELMAR NY
12054-1227
US

IV. Provider business mailing address

200 DELAWARE AVE
DELMAR NY
12054-1227
US

V. Phone/Fax

Practice location:
  • Phone: 518-497-5700
  • Fax: 518-497-5704
Mailing address:
  • Phone: 518-497-5700
  • Fax: 518-497-5704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number319283
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: