Provider Demographics
NPI:1912916032
Name:MAYER-CESIANO, LUCIEN (MD)
Entity Type:Individual
Prefix:
First Name:LUCIEN
Middle Name:
Last Name:MAYER-CESIANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LUCIEN
Other - Middle Name:MAYER
Other - Last Name:CESIANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4523 BROADWAY
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040
Mailing Address - Country:US
Mailing Address - Phone:212-567-5555
Mailing Address - Fax:212-567-5588
Practice Address - Street 1:4523 BROADWAY
Practice Address - Street 2:APT 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-2415
Practice Address - Country:US
Practice Address - Phone:212-567-5555
Practice Address - Fax:212-567-5588
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:2008-04-25
Provider Licenses
StateLicense IDTaxonomies
NY106187207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00186250Medicaid
NY00186250Medicaid
NY844611Medicare ID - Type Unspecified