Provider Demographics
NPI:1942490669
Name:ALFANO, TERESA L (NP-C)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:ALFANO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 SEAVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-4618
Mailing Address - Country:US
Mailing Address - Phone:516-484-6093
Mailing Address - Fax:516-484-6180
Practice Address - Street 1:50 SEAVIEW BLVD
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-4618
Practice Address - Country:US
Practice Address - Phone:516-484-6093
Practice Address - Fax:516-484-6180
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304671363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health