Healthcare Provider Details

I. General information

NPI: 1528245453
Provider Name (Legal Business Name): DR. TERENCE D TAYLOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 S OYSTER BAY RD
PLAINVIEW NY
11803-3329
US

IV. Provider business mailing address

866 DURHAM RD
EAST MEADOW NY
11554-4603
US

V. Phone/Fax

Practice location:
  • Phone: 516-938-5700
  • Fax: 516-937-1591
Mailing address:
  • Phone: 516-564-0037
  • Fax: 516-937-1591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number047647
License Number StateNY

VII. Legacy identifiers

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

# 1
Identifier00551675
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: