Provider Demographics
NPI:1821037664
Name:CERVENY, K. ANDREW JR (MD)
Entity Type:Individual
Prefix:
First Name:K. ANDREW
Middle Name:
Last Name:CERVENY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KENNETH
Other - Middle Name:ANDREW
Other - Last Name:CERVENY
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:604 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-2505
Mailing Address - Country:US
Mailing Address - Phone:516-432-0011
Mailing Address - Fax:516-432-1686
Practice Address - Street 1:604 E PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2505
Practice Address - Country:US
Practice Address - Phone:516-432-0011
Practice Address - Fax:516-432-1686
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240053207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology