Healthcare Provider Details

I. General information

NPI: 1942462205
Provider Name (Legal Business Name): JENNIFER R BODEN CERONE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 NEW SCOTLAND AVE MAIL CODE 101
ALBANY NY
12208-3412
US

IV. Provider business mailing address

43 NEW SCOTLAND AVENUE MAIL CODE 101
ALBANY NY
12208
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-5421
  • Fax: 518-262-5881
Mailing address:
  • Phone: 518-262-5421
  • Fax: 518-262-5881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number257802
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number257802
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: