Provider Demographics
NPI:1194984237
Name:CEDENO, RICHARD J (PA)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:J
Last Name:CEDENO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:5610 94TH ST APT 5B
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5023
Mailing Address - Country:US
Mailing Address - Phone:917-371-8772
Mailing Address - Fax:
Practice Address - Street 1:2901 3RD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-2638
Practice Address - Country:US
Practice Address - Phone:718-993-5093
Practice Address - Fax:718-993-5099
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY011166363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical