Basic Information
| Provider Information | |||||||||
| NPI: | 1841206018 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CERVONE | ||||||||
| FirstName: | AGOSTINO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 185 OLD COUNTRY RD | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | RIVERHEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 119012121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312984479 | ||||||||
| FaxNumber: | 6315913047 | ||||||||
| Practice Location | |||||||||
| Address1: | 34 COMMERCE AVE | ||||||||
| Address2: | |||||||||
| City: | RIVERHEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 119013118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312849250 | ||||||||
| FaxNumber: | 6312849249 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 02/05/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 214964 | NY | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.