Doctor Name: | JACLYN TERESCO |
NPI Number: | 1023447752 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA |
License Number: | 017062 |
Business Practice Address: | 104 Forest Ave Glen Cove, NY - 115422015 |
Business Phone Number: | 5167595406 |
Business Fax Number: | |
Mailing Address: | 104 Forest Ave, GLEN COVE |
State: | NY |
Postal Code: | 115422015 |
Phone Number: | 5167595406 |
Fax Number: | |
NPI Enumeration Date: | 11/04/2013 |
NPI Last Update Date: | 11/04/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 017062 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |