Healthcare Provider Details

I. General information

NPI: 1396743274
Provider Name (Legal Business Name): JAMES ROBERT CELLA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 W MERRICK RD
VALLEY STREAM NY
11580-5236
US

IV. Provider business mailing address

509 W MERRICK RD
VALLEY STREAM NY
11580-5236
US

V. Phone/Fax

Practice location:
  • Phone: 516-825-3955
  • Fax: 516-568-0226
Mailing address:
  • Phone: 516-825-3955
  • Fax: 516-568-0226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number031913
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: