Provider Demographics
NPI:1336379726
Name:CESARE, WILLIAM JR (CASAC)
Entity Type:Individual
Prefix:PROF
First Name:WILLIAM
Middle Name:
Last Name:CESARE
Suffix:JR
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 RUSKIN AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13207-1324
Mailing Address - Country:US
Mailing Address - Phone:315-361-9131
Mailing Address - Fax:315-361-4526
Practice Address - Street 1:1019 NORTHSIDE SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-4901
Practice Address - Country:US
Practice Address - Phone:315-361-9131
Practice Address - Fax:315-361-4526
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02140710Medicaid