Provider Demographics
NPI:1518150861
Name:TERLITZKY, STEPHEN FENNING
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:FENNING
Last Name:TERLITZKY
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:STEPHEN
Other - Middle Name:
Other - Last Name:FENNING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ACUPUNCTURIST
Mailing Address - Street 1:484 WEST 43 STREET
Mailing Address - Street 2:29E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-6330
Mailing Address - Country:US
Mailing Address - Phone:212-564-5324
Mailing Address - Fax:
Practice Address - Street 1:484 WEST 43 ST.
Practice Address - Street 2:29E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-6330
Practice Address - Country:US
Practice Address - Phone:212-564-5324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000238-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist