MEDICARE: K. ANDREW CERVENY JR. MD

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	207N00000X	Dermatology Physician	240053	NY

General Provider Information

NPI Number	:	1821037664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	K. ANDREW CERVENY JR. MD

Provider Business Mailing Address
First Line	:	604 E PARK AVE
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-2505
Country	:	US
Telephone Number	:	516-432-0011
Fax Number	:	516-432-1686

Provider Business Practice Location Address
First Line	:	604 E PARK AVE
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-2505
Country	:	US
Telephone Number	:	516-432-0011
Fax Number	:	516-432-1686

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	07/05/2011

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