Provider Demographics
NPI:1033300751
Name:JOHN V CELENTANO PHYS, PC
Entity Type:Organization
Organization Name:JOHN V CELENTANO PHYS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:V
Authorized Official - Last Name:CELENTANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-874-2900
Mailing Address - Street 1:516 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:EAST MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11940-1225
Mailing Address - Country:US
Mailing Address - Phone:631-874-2900
Mailing Address - Fax:631-874-2948
Practice Address - Street 1:516 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:EAST MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11940-1225
Practice Address - Country:US
Practice Address - Phone:631-874-2900
Practice Address - Fax:631-874-2948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02526378Medicaid
NYW89111Medicare PIN