Provider Demographics
NPI:1093706046
Name:CERRUTI, JORGE S (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:S
Last Name:CERRUTI
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 1:250 STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-2727
Mailing Address - Country:US
Mailing Address - Phone:516-742-8250
Mailing Address - Fax:516-678-8405
Practice Address - Street 1:2000 N VILLAGE AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-1078
Practice Address - Country:US
Practice Address - Phone:516-678-2232
Practice Address - Fax:516-678-8405
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100666174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY520451Medicare ID - Type Unspecified
NYB15940Medicare UPIN