Provider Demographics
NPI:1710989249
Name:CELESTIN, JOCELYN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOCELYN
Middle Name:
Last Name:CELESTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 WASHINGTON AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-5300
Mailing Address - Country:US
Mailing Address - Phone:518-264-2510
Mailing Address - Fax:518-264-2520
Practice Address - Street 1:215 WASHINGTON AVENUE EXT
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-5534
Practice Address - Country:US
Practice Address - Phone:518-452-2510
Practice Address - Fax:518-452-2683
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204070-1207K00000X, 2080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01716090Medicaid
NY01716090Medicaid
NYBB0820Medicare ID - Type Unspecified