Healthcare Provider Details

I. General information

NPI: 1164957767
Provider Name (Legal Business Name): NESTOR CERDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2017
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 N MAIN ST
NEW SQUARE NY
10977-8916
US

IV. Provider business mailing address

3 SADORE LN APT 4G
YONKERS NY
10710-4729
US

V. Phone/Fax

Practice location:
  • Phone: 845-354-9300
  • Fax:
Mailing address:
  • Phone: 914-414-0668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number25MA11234100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number307803
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number307803
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: