Provider Demographics
NPI:1275661993
Name:CERVONE, OSWALD (DO)
Entity Type:Individual
Prefix:
First Name:OSWALD
Middle Name:
Last Name:CERVONE
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 1:241 OLD BEACH GLEN RD
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866
Mailing Address - Country:US
Mailing Address - Phone:973-586-6808
Mailing Address - Fax:
Practice Address - Street 1:891 TABOR ROAD
Practice Address - Street 2:
Practice Address - City:MORRIS PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07950
Practice Address - Country:US
Practice Address - Phone:973-359-8859
Practice Address - Fax:973-359-8860
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB056780207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ687204N3HMedicare ID - Type Unspecified
E98030Medicare UPIN