1508049420 NPI number — THOMAS CERILLO DPMPC

Table of content: (NPI 1508049420)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508049420 NPI number — THOMAS CERILLO DPMPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS CERILLO DPMPC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508049420
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
116 KRAFT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRONXVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10708-4134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-337-1251
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
116 KRAFT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRONXVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10708-4134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-337-1251
Provider Business Practice Location Address Fax Number:
914-793-7473
Provider Enumeration Date:
12/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CERILLO
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
914-337-1251

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  N002655 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0055370 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0C9377 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P44193992 . This is a "MULTIPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02724752 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: TC0P304610 . This is a "HEALTH CHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 003048 . This is a "CONNECTICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 030002655NY01 . This is a "ANTHEM HEALTH AND LIFE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 134800 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4126153 . This is a "MVP HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P30461 . This is a "MD NY HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: WS1075 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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