Provider Demographics
NPI:1063473742
Name:CEJA, MANUEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:A
Last Name:CEJA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4840 194TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11365-1222
Mailing Address - Country:US
Mailing Address - Phone:718-428-4295
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 75 STE 247249
Practice Address - Street 2:JFK INTERNATIONAL AIRPORT
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11430-1802
Practice Address - Country:US
Practice Address - Phone:718-656-9500
Practice Address - Fax:718-656-9503
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174494207R00000X, 2083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00311201Medicaid
NYE12817Medicare UPIN
NY30352Medicare PIN