Provider Demographics
NPI:1659307510
Name:CELESTINO, CECILIA CRUZ (MD)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:CRUZ
Last Name:CELESTINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 PITTSTOWN ROAD
Mailing Address - Street 2:HUNTERDON DEVELOPMENTAL CENTER
Mailing Address - City:CLINTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08809-4003
Mailing Address - Country:US
Mailing Address - Phone:908-730-5702
Mailing Address - Fax:908-730-1340
Practice Address - Street 1:HUNTERDON DEVELOPMENTAL CENTER
Practice Address - Street 2:40 PITTSTOWN ROAD
Practice Address - City:CLINTON
Practice Address - State:NJ
Practice Address - Zip Code:08809-4003
Practice Address - Country:US
Practice Address - Phone:908-730-5702
Practice Address - Fax:908-730-1340
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07590400208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ073370B1LOtherMEDICARE BILLING NO.
NJ073370B1LOtherMEDICARE BILLING NO.