Healthcare Provider Details

I. General information

NPI: 1205198991
Provider Name (Legal Business Name): THERESA CERAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2012
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 WESTCHESTER AVE
WHITE PLAINS NY
10604-3516
US

IV. Provider business mailing address

2253 MARK RD
YORKTOWN HEIGHTS NY
10598-3522
US

V. Phone/Fax

Practice location:
  • Phone: 914-576-5292
  • Fax:
Mailing address:
  • Phone: 914-715-7390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number566350111
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: