Provider Demographics
NPI:1164143046
Name:TERRANOVA MEDICAL, PLLC
Entity Type:Organization
Organization Name:TERRANOVA MEDICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANTO
Authorized Official - Middle Name:PRIMO
Authorized Official - Last Name:TERRANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:914-574-6161
Mailing Address - Street 1:778 WHITE PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-5005
Mailing Address - Country:US
Mailing Address - Phone:914-574-6161
Mailing Address - Fax:914-340-0740
Practice Address - Street 1:778 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-5005
Practice Address - Country:US
Practice Address - Phone:914-574-6161
Practice Address - Fax:914-340-0740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty