Provider Demographics
NPI:1467402784
Name:TERZELLA, MICHAEL JOHN (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOHN
Last Name:TERZELLA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NORTHERN BLVD PO BOX 8000
Mailing Address - Street 2:ACADEMIC HEALTH CARE CENTER NY INSTITUTE OF TECHNOLOGY
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-8000
Mailing Address - Country:US
Mailing Address - Phone:516-686-1300
Mailing Address - Fax:
Practice Address - Street 1:NORTHERN BLVD
Practice Address - Street 2:ACADEMIC HEALTH CARE CENTER NY INSTITUTE OF TECHNOLOGY
Practice Address - City:OLD WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11568-8000
Practice Address - Country:US
Practice Address - Phone:516-686-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219892204D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH71624Medicare UPIN