Provider Demographics
NPI:1164423034
Name:SURGICAL INTENSIVISTS, PC
Entity Type:Organization
Organization Name:SURGICAL INTENSIVISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CERABONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-493-7221
Mailing Address - Street 1:NYMC MUNGER PAVILION DEPT SURGERY
Mailing Address - Street 2:ROOM 224
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1652
Mailing Address - Country:US
Mailing Address - Phone:914-493-7621
Mailing Address - Fax:914-594-4359
Practice Address - Street 1:19 BRADHURST AVE
Practice Address - Street 2:SUITE 1700
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2140
Practice Address - Country:US
Practice Address - Phone:914-347-0162
Practice Address - Fax:914-347-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208600000X, 2086X0206X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00959242Medicaid
NYW94181Medicare PIN