Healthcare Provider Details

I. General information

NPI: 1578083564
Provider Name (Legal Business Name): ANTHONY JOSHUA CERCIELLO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MARCUS AVE STE N10
NEW HYDE PARK NY
11042-2048
US

IV. Provider business mailing address

2001 MARCUS AVE STE N10
NEW HYDE PARK NY
11042-2048
US

V. Phone/Fax

Practice location:
  • Phone: 516-775-1818
  • Fax: 516-775-0892
Mailing address:
  • Phone: 516-775-1818
  • Fax: 516-775-0892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number06188801
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number06188801
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: