Provider Demographics
NPI:1134228679
Name:CERVENAK, BETTY ANN (MD)
Entity type:Individual
Prefix:DR
First Name:BETTY
Middle Name:ANN
Last Name:CERVENAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BETTY
Other - Middle Name:ANN
Other - Last Name:PANARIELLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:203 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1112
Mailing Address - Country:US
Mailing Address - Phone:201-653-5722
Mailing Address - Fax:201-792-9718
Practice Address - Street 1:203 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1112
Practice Address - Country:US
Practice Address - Phone:201-653-5722
Practice Address - Fax:201-792-9718
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA40986207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4797809Medicaid
NJ180018116OtherRAILROAD MEDICARE
NJ180018116OtherRAILROAD MEDICARE