MEDICARE: P.A. TERRACIANO, M.D., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	91750	NY
2	207W00000X	Ophthalmology Physician	214528	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	424B0DW311	OTHER		ANTHONY TERRACIANO, MD
2	49666DW311	OTHER		PASQUAL TERRACIANO, MD

General Provider Information

NPI Number	:	1184637662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	P.A. TERRACIANO, M.D., P.C.

Provider Business Mailing Address
First Line	:	2241 ESPLANADE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-5405
Country	:	US
Telephone Number	:	718-654-7122
Fax Number	:

Provider Business Practice Location Address
First Line	:	2241 ESPLANADE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-5405
Country	:	US
Telephone Number	:	718-654-7122
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. ANTHONY TERRACIANO
Credential	:	MD
Telephone Number	:	718-654-7122

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	10/23/2007

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