Provider Demographics
NPI:1508049420
Name:THOMAS CERILLO DPMPC
Entity Type:Organization
Organization Name:THOMAS CERILLO DPMPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CERILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:914-337-1251
Mailing Address - Street 1:116 KRAFT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-4134
Mailing Address - Country:US
Mailing Address - Phone:914-337-1251
Mailing Address - Fax:
Practice Address - Street 1:116 KRAFT AVE
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-4134
Practice Address - Country:US
Practice Address - Phone:914-337-1251
Practice Address - Fax:914-793-7473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002655213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0055370OtherGHI
NY0C9377OtherHEALTHNET
NYP44193992OtherMULTIPLAN
NY02724752Medicaid
NYTC0P304610OtherHEALTH CHOICE
NY003048OtherCONNECTICARE
NY030002655NY01OtherANTHEM HEALTH AND LIFE
NY134800OtherUNITED HEALTH CARE
NY4126153OtherMVP HEALTH PLAN
NYP30461OtherMD NY HEALTH PLAN
NYWS1075OtherOXFORD
NY4126153OtherMVP HEALTH PLAN
NY=========OtherHUMANA
NYP30461OtherMD NY HEALTH PLAN
NY4126153OtherMVP HEALTH PLAN
NY=========OtherEMPIRE METROPOLITAN LIFE
NY=========001OtherPRUDENTIAL
NYDH1036Medicare PIN