Provider Demographics
NPI:1750375036
Name:CERABONA, THOMAS DOMINIC (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:DOMINIC
Last Name:CERABONA
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 1:19 BRADHURST AVE
Mailing Address - Street 2:STE 1700
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-2139
Mailing Address - Country:US
Mailing Address - Phone:914-493-7621
Mailing Address - Fax:914-594-4359
Practice Address - Street 1:19 BRADHURST AVE
Practice Address - Street 2:SUITE 1700
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2140
Practice Address - Country:US
Practice Address - Phone:914-347-0162
Practice Address - Fax:914-347-4401
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY157012208600000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01099274Medicaid
NY22E4494181Medicare PIN
NY22E441Medicare PIN
NYD91772Medicare UPIN