Provider Demographics
NPI:1992835672
Name:MUNDY, TERRENCE JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:JOHN
Last Name:MUNDY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12910 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:BELLE HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11694
Mailing Address - Country:US
Mailing Address - Phone:718-634-4800
Mailing Address - Fax:718-474-0735
Practice Address - Street 1:12910 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:BELLE HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11694
Practice Address - Country:US
Practice Address - Phone:718-634-4800
Practice Address - Fax:718-474-0735
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0083941111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12151Medicare PIN
12151HMedicare UPIN