Basic Information
Provider Information | |||||||||
NPI: | 1497293831 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GRIFFITH | ||||||||
FirstName: | TERSHA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1 PENN PLAZA | ||||||||
Address2: | 8TH FL | ||||||||
City: | NEW YORK | ||||||||
State: | NY | ||||||||
PostalCode: | 10119 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2122166400 | ||||||||
FaxNumber: | 2122166606 | ||||||||
Practice Location | |||||||||
Address1: | 1 PENN PLAZA | ||||||||
Address2: | 8TH FL | ||||||||
City: | NEW YORK | ||||||||
State: | NY | ||||||||
PostalCode: | 10119 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2122166400 | ||||||||
FaxNumber: | 2122166606 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/06/2017 | ||||||||
LastUpdateDate: | 02/06/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SG0600X | 307756-1 | NY | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Gerontology |
No ID Information.