Healthcare Provider Details

I. General information

NPI: 1831659028
Provider Name (Legal Business Name): JESSICA MARIE CELENZA-SALVATORE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3014 CRESCENT ST
ASTORIA NY
11102-3249
US

IV. Provider business mailing address

3014 CRESCENT ST
ASTORIA NY
11102-3249
US

V. Phone/Fax

Practice location:
  • Phone: 718-808-7241
  • Fax:
Mailing address:
  • Phone: 718-808-7241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number314868
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number314868
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number314868
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: