Healthcare Provider Details

I. General information

NPI: 1629105713
Provider Name (Legal Business Name): TERAH J STIELL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 CROSSWAYS PARK DR STE 101
WOODBURY NY
11797-2038
US

IV. Provider business mailing address

900 MERCHANTS CONCOURSE STE 216
WESTBURY NY
11590-5114
US

V. Phone/Fax

Practice location:
  • Phone: 516-496-3900
  • Fax:
Mailing address:
  • Phone: 516-226-8373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number010675
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: