MEDICARE: IXEL CERVERA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	283418	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	283418	OTHER	NY	MEDICAL LICENSE

General Provider Information

NPI Number	:	1801239090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IXEL CERVERA M.D.

Provider Business Mailing Address
First Line	:	1811 HONE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-1406
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1811 HONE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-1406
Country	:	US
Telephone Number	:	516-499-9016
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2013
Last Update Date	:	09/16/2024

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