Basic Information
| Provider Information | |||||||||
| NPI: | 1083824460 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GARDEN CITY PLAZA OFFICE BASED SURGERY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 GARDEN CITY PLZ | ||||||||
| Address2: | 100 | ||||||||
| City: | GARDEN CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115303301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166636400 | ||||||||
| FaxNumber: | 5166636404 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 | ||||||||
| Address2: | GARDEN CITY PLAZA SUITE 100 | ||||||||
| City: | GARDEN CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166636400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | TERANNI | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5166636400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 197817 | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.