MEDICARE: DR. DENIZ CEREB MD

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	208000000X	Pediatrics Physician	200270	NY
2	2080A0000X	Pediatric Adolescent Medicine Physician	200270	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538133178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENIZ CEREB MD

Provider Business Mailing Address
First Line	:	2066 RICHMOND AVENUE
Second Line	:	1ST FLOOR
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3916
Country	:	US
Telephone Number	:	718-982-9001
Fax Number	:	718-982-9008

Provider Business Practice Location Address
First Line	:	2066 RICHMOND AVENUE
Second Line	:	1ST FLOOR
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3916
Country	:	US
Telephone Number	:	718-982-9001
Fax Number	:	718-982-9008

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

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	08/19/2010

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Directions to “ DR. DENIZ CEREB MD” Practice Location

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