Provider Demographics
NPI:1154418044
Name:CERQUEIRA RYO, PAULA MARIA (DO)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:MARIA
Last Name:CERQUEIRA RYO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:PAULA
Other - Middle Name:M
Other - Last Name:CERQUEIRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:600 NORTHERN BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11568-1214
Mailing Address - Country:US
Mailing Address - Phone:516-686-7773
Mailing Address - Fax:
Practice Address - Street 1:600 NORTHERN BOULEVARD
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:NY
Practice Address - Zip Code:11568-1214
Practice Address - Country:US
Practice Address - Phone:516-686-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240223207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03222387Medicaid
A400026447Medicare PIN