MEDICARE: ELISE CERILLO LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	013571	NY

General Provider Information

NPI Number	:	1164370128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISE CERILLO LMT

Provider Business Mailing Address
First Line	:	PO BOX 735
Second Line	:
City	:	WARWICK
State	:	NY
Zip	:	10990-0735
Country	:	US
Telephone Number	:	407-948-0522
Fax Number	:

Provider Business Practice Location Address
First Line	:	290 MAIN ST STE 4
Second Line	:
City	:	COLD SPRING
State	:	NY
Zip	:	10516-1409
Country	:	US
Telephone Number	:	845-240-1822
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	03/17/2026

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