Provider Demographics
NPI:1215084512
Name:JOSE F. CERVANTES JR. MD PLLC
Entity type:Organization
Organization Name:JOSE F. CERVANTES JR. MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:FELIPE
Authorized Official - Last Name:CERVANTES
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:718-835-1056
Mailing Address - Street 1:12239 135TH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-3238
Mailing Address - Country:US
Mailing Address - Phone:718-835-1056
Mailing Address - Fax:718-835-2769
Practice Address - Street 1:12239 135TH AVE
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-3238
Practice Address - Country:US
Practice Address - Phone:718-835-1056
Practice Address - Fax:718-835-2769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY159085207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01013372Medicaid
NY137245OtherWELLCARE OF NY
NY159085OtherHIP
NY159085-B17OtherHEALTH FIRST
NY2605940OtherUNITED HEALTHCARE
NYP00000070683OtherGHI MEDICARE CHOICE PPO
NY0553273OtherCIGNA HEALTHCARE
NY1000016335OtherAFFINITY HEALTH PLAN
NY2Z603OtherEMPIRE BLUE CROSS BLUE SH
NY78371OtherVYTRA HEALTHCARE
NYP00388302OtherRAILROAD MEDICARE
NY1201510OtherAETNA
NY1569153-1Other1199 NATIONAL BENEFIT FUN
NYP3715361OtherOXFORD HEALTH PLAN
NY160124OtherELDERPLAN
NY6C0541OtherHEALTHNET
NY7299185OtherGHI
NY2605940OtherUNITED HEALTHCARE
NYA65010Medicare UPIN