MEDICARE: TERRYVILLE MEDICAL ASSOCIATES

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1275596447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TERRYVILLE MEDICAL ASSOCIATES

Provider Business Mailing Address
First Line	:	116 TERRYVILLE RD
Second Line	:
City	:	PORT JEFFERSON STATION
State	:	NY
Zip	:	11776-1329
Country	:	US
Telephone Number	:	631-928-2002
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 TERRYVILLE RD
Second Line	:
City	:	PORT JEFFERSON STATION
State	:	NY
Zip	:	11776-1329
Country	:	US
Telephone Number	:	631-928-2002
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN BIASETTI
Credential	:	M.D.
Telephone Number	:	631-928-2002

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	08/22/2020

Similar Medicare Providers

1639158678 — DR. RICHARD JOHN WIETING M.D.
Practice Location Address:

116 TERRYVILLE RD
PORT JEFFERSON STATION, NY
11776-1329

Practice Phone: 631-928-2002
Practice Fax: 631-928-4934

1295714277 — TERRYVILLE MEDICAL ASSOCIATES
Practice Location Address:

116 TERRYVILLE RD
PORT JEFFERSON STATION, NY
11776-1329

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1497729099 — DR. JOHN J RICCIARDELLI M.D.
Practice Location Address:

112 TERRYVILLE RD
PORT JEFFERSON STATION, NY
11776-1329

Practice Phone: 631-473-3900
Practice Fax: 631-474-4475

1609839893 — MS. KARIN MARIE KEYES LCSW
Practice Location Address:

108 TERRYVILLE RD
PORT JEFFERSON STATION, NY
11776-1329

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1346280658 — SANJAY SANGWAN M.D.
Practice Location Address:

116 TERRYVILLE RD
PORT JEFFERSON STATION, NY
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1083728323 — ANIL SANGWAN M.D.
Practice Location Address:

116 TERRYVILLE RD
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11776-1329

Practice Phone: 631-928-2002
Practice Fax: 631-473-4427

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