Provider Demographics
NPI:1780241265
Name:CERRI & DROZ MEDICAL ASSOCIATES, PLLC
Entity type:Organization
Organization Name:CERRI & DROZ MEDICAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:CERRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-710-0695
Mailing Address - Street 1:24175A OAK PARK DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11362-2643
Mailing Address - Country:US
Mailing Address - Phone:516-710-0695
Mailing Address - Fax:516-945-0887
Practice Address - Street 1:2818 STEINWAY ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3349
Practice Address - Country:US
Practice Address - Phone:929-296-3726
Practice Address - Fax:929-296-3723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3063774Medicaid
NY4848284Medicaid