Provider Demographics
NPI:1194750505
Name:CERVO, FRANK (MD)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:
Last Name:CERVO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PATRIOTS RD
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-3318
Mailing Address - Country:US
Mailing Address - Phone:631-444-8608
Mailing Address - Fax:631-444-8778
Practice Address - Street 1:100 PATRIOTS RD
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-3318
Practice Address - Country:US
Practice Address - Phone:631-444-8608
Practice Address - Fax:631-444-8778
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156362207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01453272Medicaid
NY54D45OtherEMPIRE BC.BS
NY5077108OtherAETNA
NY01453272Medicaid
NY54D45OtherEMPIRE BC.BS