Provider Demographics
NPI:1609976281
Name:CERRETO, DOMINIC S (DC)
Entity Type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:S
Last Name:CERRETO
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 1:237 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-2701
Mailing Address - Country:US
Mailing Address - Phone:973-667-4005
Mailing Address - Fax:
Practice Address - Street 1:237 CENTRE ST
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-2701
Practice Address - Country:US
Practice Address - Phone:973-667-4005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC004510111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ771044Medicare ID - Type UnspecifiedPROVIDER NUMBER