Healthcare Provider Details

I. General information

NPI: 1972074664
Provider Name (Legal Business Name): TERRI LEE MCCLUSKEY MS, RN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2018
Last Update Date: 12/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 RAMAPO RD STE 4
GARNERVILLE NY
10923-1595
US

IV. Provider business mailing address

467 WESTERN HWY
ORANGEBURG NY
10962-1205
US

V. Phone/Fax

Practice location:
  • Phone: 845-947-1772
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number342466
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: