Provider Demographics
NPI:1417036708
Name:MICHAEL D. TERRANOVA & MARK D. BEZBATCHENKO PTR
Entity Type:Organization
Organization Name:MICHAEL D. TERRANOVA & MARK D. BEZBATCHENKO PTR
Other - Org Name:LANCASTER-DEPEW PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-684-6140
Mailing Address - Street 1:5330 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:BOWMANSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14026-1035
Mailing Address - Country:US
Mailing Address - Phone:716-684-6140
Mailing Address - Fax:
Practice Address - Street 1:5330 GENESEE ST
Practice Address - Street 2:
Practice Address - City:BOWMANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14026-1035
Practice Address - Country:US
Practice Address - Phone:716-684-6140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty