1508049420 NPI number — THOMAS CERILLO DPMPC

Table of Contents

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".




Copyright © 2007-2025 www.npivalidator.com