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General NPI Number Information
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NPI Number | 1184946956
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Entity Type | Organization
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Legal Business Name | TERAGRAM I, INC.
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Dates
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Enumeration Date | 02/22/2010
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Last Update Date | 02/22/2010
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Provider Practice Location Address
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Address Line | 881 BROADWAY MALL
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City | HICKSVILLE
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State | NY
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Zip | 11801-2712
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Country | US
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Telephone | 516-938-6006
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Fax | 516-938-6018
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Provider Business Mailing Address
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Address Line | 881 BROADWAY MALL
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City | HICKSVILLE
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State | NY
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Zip | 11801-2712
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MS. MARGARET S DERAGO
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Credential |
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Telephone | 516-938-6006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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