Provider Demographics
NPI:1053495176
Name:CERONE, SAMUEL MICHAEL (MSPT)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:MICHAEL
Last Name:CERONE
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940
Mailing Address - Country:US
Mailing Address - Phone:845-342-5170
Mailing Address - Fax:845-343-3278
Practice Address - Street 1:152 ORANGE AVE
Practice Address - Street 2:
Practice Address - City:WALDEN
Practice Address - State:NY
Practice Address - Zip Code:12586
Practice Address - Country:US
Practice Address - Phone:845-778-1552
Practice Address - Fax:845-778-7642
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0231371225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQP2361Medicare ID - Type Unspecified
NYQ2WLM3Medicare ID - Type Unspecified