Provider Demographics
NPI:1740694157
Name:BIRISAN, CECILIA NATALIA ESTEBAN (MD)
Entity type:Individual
Prefix:DR
First Name:CECILIA NATALIA
Middle Name:ESTEBAN
Last Name:BIRISAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321B CROSSWAYS PARK DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2066
Mailing Address - Country:US
Mailing Address - Phone:631-470-1450
Mailing Address - Fax:
Practice Address - Street 1:321B CROSSWAYS PARK DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2066
Practice Address - Country:US
Practice Address - Phone:631-470-1450
Practice Address - Fax:631-470-1451
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10815500208C00000X, 208C00000X
NY312905208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FB8311247OtherDEA