Provider Demographics
NPI:1851770507
Name:TERRACCIANO, JAIME
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:TERRACCIANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 ARDEN LN
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-1301
Mailing Address - Country:US
Mailing Address - Phone:631-525-9753
Mailing Address - Fax:
Practice Address - Street 1:11 ARDEN LN
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-1301
Practice Address - Country:US
Practice Address - Phone:631-525-9753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program