Provider Demographics
NPI:1780969535
Name:CECILIA TESORO ARBOLEDA, MDPC
Entity type:Organization
Organization Name:CECILIA TESORO ARBOLEDA, MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:TESORO
Authorized Official - Last Name:ARBOLEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-229-0790
Mailing Address - Street 1:4305 ALBANY POST RD
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-3601
Mailing Address - Country:US
Mailing Address - Phone:845-229-0790
Mailing Address - Fax:845-229-1749
Practice Address - Street 1:4305 ALBANY POST RD
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-3601
Practice Address - Country:US
Practice Address - Phone:845-229-0790
Practice Address - Fax:845-229-1749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117294261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center