Provider Demographics
NPI:1669230835
Name:CISERANO, EMILY ROSE
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ROSE
Last Name:CISERANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 WOODBURY RD
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-4728
Mailing Address - Country:US
Mailing Address - Phone:631-406-3859
Mailing Address - Fax:
Practice Address - Street 1:403 RIDGEFIELD RD
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2313
Practice Address - Country:US
Practice Address - Phone:631-406-3859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069238183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist