Provider Demographics
NPI:1992855621
Name:ALFONSO, CESAR A (MD)
Entity Type:Individual
Prefix:DR
First Name:CESAR
Middle Name:A
Last Name:ALFONSO
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 1:251 CENTRAL PARK W APT 1A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-4111
Mailing Address - Country:US
Mailing Address - Phone:917-496-7614
Mailing Address - Fax:
Practice Address - Street 1:251 CENTRAL PARK W APT 1A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-4111
Practice Address - Country:US
Practice Address - Phone:917-496-7614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185067-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY68I041Medicare ID - Type Unspecified
NYF77049Medicare UPIN