Healthcare Provider Details

I. General information

NPI: 1184720633
Provider Name (Legal Business Name): ERNEST S TERRANOVA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HARBOR PL
SOUTH SALEM NY
10590-1505
US

IV. Provider business mailing address

1 HARBOR PL
SOUTH SALEM NY
10590-1505
US

V. Phone/Fax

Practice location:
  • Phone: 914-666-7722
  • Fax: 914-244-8859
Mailing address:
  • Phone: 914-666-7722
  • Fax: 914-244-8859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number144202
License Number StateNY

VIII. Authorized Official

Name: ERNEST S TERRANOVA
Title or Position: PRESIDENT OF CORPORATION
Credential: M.D.
Phone: 914-666-7722