Provider Demographics
NPI:1407912868
Name:CERESNAK, JEFFREY M (MD,)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:CERESNAK
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 EAST 210TH STREET
Mailing Address - Street 2:MMC-ATTENDING SERVICE, MEDICINE
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467
Mailing Address - Country:US
Mailing Address - Phone:718-920-4444
Mailing Address - Fax:
Practice Address - Street 1:111 EAST 210TH STREET
Practice Address - Street 2:MMC-ATTENDING SERVICE, MEDICINE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-920-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241434-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine