Provider Demographics
NPI:1578672259
Name:TERRANELLA, JOHN P (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:TERRANELLA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1368 CLOVE RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-4303
Mailing Address - Country:US
Mailing Address - Phone:718-983-8080
Mailing Address - Fax:718-816-5465
Practice Address - Street 1:1368 CLOVE RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-4303
Practice Address - Country:US
Practice Address - Phone:718-983-8080
Practice Address - Fax:718-816-5465
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003649213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00789217Medicaid
NYP37681Medicare ID - Type Unspecified
NY00789217Medicaid
NY5323330001Medicare NSC