Healthcare Provider Details

I. General information

NPI: 1700317195
Provider Name (Legal Business Name): TERRY VUONG D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 UNDERHILL BLVD STE 190
SYOSSET NY
11791-3494
US

IV. Provider business mailing address

575 UNDERHILL BLVD STE 190
SYOSSET NY
11791-3494
US

V. Phone/Fax

Practice location:
  • Phone: 516-210-8840
  • Fax:
Mailing address:
  • Phone: 516-210-8840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number301480
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number301480
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: