Provider Demographics
NPI:1629150263
Name:CERNIGLIA, ROSE (DO)
Entity Type:Individual
Prefix:DR
First Name:ROSE
Middle Name:
Last Name:CERNIGLIA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FATHERS CT
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4902
Mailing Address - Country:US
Mailing Address - Phone:631-673-2989
Mailing Address - Fax:
Practice Address - Street 1:156 1ST ST
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4084
Practice Address - Country:US
Practice Address - Phone:516-741-4082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195449208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics