Healthcare Provider Details

I. General information

NPI: 1114386083
Provider Name (Legal Business Name): CESARETTI ONCOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2016
Last Update Date: 02/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1781 HYLAN BLVD
STATEN ISLAND NY
10305-1917
US

IV. Provider business mailing address

1781 HYLAN BLVD
STATEN ISLAND NY
10305-1917
US

V. Phone/Fax

Practice location:
  • Phone: 718-351-9750
  • Fax: 718-351-9753
Mailing address:
  • Phone: 718-351-9750
  • Fax: 718-351-9753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number223361
License Number StateNY

VIII. Authorized Official

Name: JAMIE ALLAN CESARETTI
Title or Position: OWNER
Credential: M.D.
Phone: 718-351-9750