1780647743 NPI number — TERENCE MICHAEL MCELGUN D.P.M.

Table of content: TERENCE MICHAEL MCELGUN D.P.M. (NPI 1780647743)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780647743 NPI number — TERENCE MICHAEL MCELGUN D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCELGUN
Provider First Name:
TERENCE
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCELGUN
Provider Other First Name:
TERENCE
Provider Other Middle Name:
MICHAEL
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.P.M.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1780647743
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 FRANKLIN AVE
Provider Second Line Business Mailing Address:
SUITE 223
Provider Business Mailing Address City Name:
GARDEN CITY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11530-5801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-746-4732
Provider Business Mailing Address Fax Number:
516-746-4947

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 FRANKLIN AVE
Provider Second Line Business Practice Location Address:
SUITE 223
Provider Business Practice Location Address City Name:
GARDEN CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11530-5801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-746-4732
Provider Business Practice Location Address Fax Number:
516-746-4947
Provider Enumeration Date:
04/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0131X , with the licence number:  N004260 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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