Basic Information
| Provider Information | |||||||||
| NPI: | 1366638173 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HETRICK-PLATTE | ||||||||
| FirstName: | TERA | ||||||||
| MiddleName: | NIKOLE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 TROY SCHENECTADY RD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | LATHAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121102442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187823700 | ||||||||
| FaxNumber: | 5187823700 | ||||||||
| Practice Location | |||||||||
| Address1: | 35 EMPIRE STATE BLVD | ||||||||
| Address2: | |||||||||
| City: | CASTLETON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120339777 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184772167 | ||||||||
| FaxNumber: | 5184775182 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2007 | ||||||||
| LastUpdateDate: | 11/21/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 245727 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 02928509 | 05 | NY | MEDICAID |