Healthcare Provider Details

I. General information

NPI: 1144382714
Provider Name (Legal Business Name): TERESA ANN MCCANN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 05/16/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56-45 MAIN ST RM 4134N
FLUSHING NY
11355-5045
US

IV. Provider business mailing address

56-45 MAIN ST
FLUSHING NY
11355
US

V. Phone/Fax

Practice location:
  • Phone: 718-670-1808
  • Fax: 718-460-0164
Mailing address:
  • Phone: 718-670-1808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number227875
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number227875
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: