Healthcare Provider Details

I. General information

NPI: 1467402784
Provider Name (Legal Business Name): MICHAEL JOHN TERZELLA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NORTHERN BLVD ACADEMIC HEALTH CARE CENTER NY INSTITUTE OF TECHNOLOGY
OLD WESTBURY NY
11568-8000
US

IV. Provider business mailing address

NORTHERN BLVD PO BOX 8000 ACADEMIC HEALTH CARE CENTER NY INSTITUTE OF TECHNOLOGY
OLD WESTBURY NY
11568-8000
US

V. Phone/Fax

Practice location:
  • Phone: 516-686-1300
  • Fax:
Mailing address:
  • Phone: 516-686-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number219892
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number219892
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: