Provider Demographics
NPI:1114180882
Name:CERAULO, PHILIP (DO)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:CERAULO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 MATAWAN RD STE 302
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-2653
Mailing Address - Country:US
Mailing Address - Phone:732-441-7177
Mailing Address - Fax:732-441-7165
Practice Address - Street 1:2500 MORRIS AVE STE 220
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5675
Practice Address - Country:US
Practice Address - Phone:732-906-9600
Practice Address - Fax:732-377-0393
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08316500208100000X
FLOS102622081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine