Healthcare Provider Details

I. General information

NPI: 1871746743
Provider Name (Legal Business Name): ANTHONY DAVID CERNESKIE CCC/SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2008
Last Update Date: 10/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4693 S HILL RD
MIDDLESEX NY
14507-9609
US

IV. Provider business mailing address

4693 S HILL RD
MIDDLESEX NY
14507-9609
US

V. Phone/Fax

Practice location:
  • Phone: 585-554-5255
  • Fax:
Mailing address:
  • Phone: 585-554-5255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number007671-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: