Provider Demographics
NPI:1770886889
Name:LAVESA-CESANA, JENNIFER B (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:B
Last Name:LAVESA-CESANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:CESANA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:91 PERIMETER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13441-4018
Mailing Address - Country:US
Mailing Address - Phone:315-356-5060
Mailing Address - Fax:315-630-6013
Practice Address - Street 1:91 PERIMETER RD STE 100
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13441-4018
Practice Address - Country:US
Practice Address - Phone:315-356-5060
Practice Address - Fax:315-630-6013
Is Sole Proprietor?:No
Enumeration Date:2010-12-10
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199177-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine