Provider Demographics
NPI:1710090667
Name:CESAREO, STEPHEN A (PA)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:CESAREO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1446
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07962-1446
Mailing Address - Country:US
Mailing Address - Phone:973-538-2334
Mailing Address - Fax:973-538-6498
Practice Address - Street 1:160 E HANOVER AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-3150
Practice Address - Country:US
Practice Address - Phone:973-538-2334
Practice Address - Fax:973-538-6498
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMP123363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S09288Medicare UPIN
NJ804015B9MMedicare ID - Type Unspecified
NJ804015B9MMedicare PIN