Provider Demographics
NPI:1457346918
Name:CIERVO, ALFONSO (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFONSO
Middle Name:
Last Name:CIERVO
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 1:4 CRAPE MYRTLE DR
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1529
Mailing Address - Country:US
Mailing Address - Phone:732-380-1222
Mailing Address - Fax:
Practice Address - Street 1:142 HIGHWAY 35
Practice Address - Street 2:SUITE 106A
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-3427
Practice Address - Country:US
Practice Address - Phone:732-380-1222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06756800174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0035378Medicaid
NJ2K7795OtherHEALTHNET ID #
NJ5337R1OtherBCBS OF NY ID #
NJ2313631000OtherAMERIHEALTH ID #
NJ7790588OtherAETNA PPO ID #
NJ8221858OtherGHI PPO ID #
NJ3732796OtherAETNA HMO ID #
NJ97662OtherAMERICAID / AMERIGROUP #
NJP00158098OtherRAILROAD MEDICARE ID #
NJ0035378Medicaid
NJ8221858OtherGHI PPO ID #