Provider Demographics
NPI:1073611836
Name:CERILLO, THOMAS (DPM)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:CERILLO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-4182
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:116 KRAFT AVENUE
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-4182
Practice Address - Country:US
Practice Address - Phone:914-337-1251
Practice Address - Fax:914-793-7473
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002655213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP30461Medicare PIN
NY5295250001Medicare NSC
NY441480994Medicare PIN