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General NPI Number Information
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NPI Number | 1710148135
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Entity Type | Organization
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Legal Business Name | JOHN P TERRANELLA
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Dates
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Enumeration Date | 06/18/2008
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 2470 VICTORY BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10314-6612
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Country | US
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Telephone | 718-983-8080
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Fax |
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Provider Business Mailing Address
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Address Line | 2470 VICTORY BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10314-6612
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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 | PODIATRIST
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Name | JOHN P TERRANELLA
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Credential |
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Telephone | 718-983-8080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | NOO3649
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License Number State | NY
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