Provider Demographics
NPI:1265444673
Name:CERNIGLIA, DAVID J (DC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:J
Last Name:CERNIGLIA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MOHAWK AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTIA
Mailing Address - State:NY
Mailing Address - Zip Code:12302-2563
Mailing Address - Country:US
Mailing Address - Phone:518-374-8039
Mailing Address - Fax:518-374-0273
Practice Address - Street 1:25 MOHAWK AVE
Practice Address - Street 2:
Practice Address - City:SCOTIA
Practice Address - State:NY
Practice Address - Zip Code:12302-2565
Practice Address - Country:US
Practice Address - Phone:518-374-8039
Practice Address - Fax:518-374-0273
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0092761111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0493Medicare ID - Type Unspecified
U39249Medicare UPIN