Provider Demographics
NPI:1124244421
Name:DRS CERISE ADINOLFI AND ASSOCIATES
Entity type:Organization
Organization Name:DRS CERISE ADINOLFI AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:BOUDREAUX
Authorized Official - Last Name:LONGSTREET
Authorized Official - Suffix:
Authorized Official - Credentials:CST
Authorized Official - Phone:504-486-7415
Mailing Address - Street 1:810 CRYSTAL ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-3610
Mailing Address - Country:US
Mailing Address - Phone:504-486-7415
Mailing Address - Fax:504-891-4064
Practice Address - Street 1:3629 PRYTANIA ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3610
Practice Address - Country:US
Practice Address - Phone:504-486-7415
Practice Address - Fax:504-891-4064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0144272086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1174343Medicaid
LA5B311Medicare ID - Type UnspecifiedGROUP PROVIDER #