Provider Demographics
NPI:1093877219
Name:LUZ DEL CARMEN CESPEDES MD, PLLC
Entity Type:Organization
Organization Name:LUZ DEL CARMEN CESPEDES MD, PLLC
Other - Org Name:CESPEDES & CESPEDES MD, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERNAL MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:CESPEDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-470-4720
Mailing Address - Street 1:PO BOX 20572
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-0864
Mailing Address - Country:US
Mailing Address - Phone:631-470-4720
Mailing Address - Fax:631-470-4721
Practice Address - Street 1:33 WALT WHITMAN RD STE 240
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-4297
Practice Address - Country:US
Practice Address - Phone:631-470-4720
Practice Address - Fax:631-470-4721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229149261QP2300X
NY225451261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEZ501Medicare PIN