Provider Demographics
NPI:1902056005
Name:TERRELONGE, ROBERT LEE (NPP, ANP)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LEE
Last Name:TERRELONGE
Suffix:
Gender:M
Credentials:NPP, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 CLARENDON DR
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-2503
Mailing Address - Country:US
Mailing Address - Phone:516-376-4111
Mailing Address - Fax:516-593-1307
Practice Address - Street 1:33 CLARENDON DR
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-2503
Practice Address - Country:US
Practice Address - Phone:516-376-4111
Practice Address - Fax:516-593-1307
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400836363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health