Healthcare Provider Details

I. General information

NPI: 1609294453
Provider Name (Legal Business Name): CRISTA CERRONE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2014
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 WASHINGTON ST MEDICAL EDUCATION, 4H
HARTFORD CT
06106-3322
US

IV. Provider business mailing address

33 HICKORY ST
FLORAL PARK NY
11001-3115
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-9973
  • Fax:
Mailing address:
  • Phone: 516-996-7704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number322057
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number322057
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: