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General NPI Number Information
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NPI Number | 1467652636
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Entity Type | Individual
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Provider Name | MICHELLE ANN CERVONE MD
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Gender | Female
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Dates
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Enumeration Date | 07/24/2007
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 113 UNIVERSITY PL FL 11
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City | NEW YORK
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State | NY
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Zip | 10003-4527
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Country | US
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Telephone | 212-484-2356
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Fax | 646-486-6495
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Provider Business Mailing Address
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Address Line | 113 UNIVERSITY PL FL 11
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City | NEW YORK
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State | NY
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Zip | 10003-4527
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Country | US
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Telephone | 212-484-2356
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Fax | 646-486-6495
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 200756
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License Number State | NY
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