Provider Demographics
NPI:1326196965
Name:CERIBELLI, EDMUND F (DC)
Entity type:Individual
Prefix:
First Name:EDMUND
Middle Name:F
Last Name:CERIBELLI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 BOND ST
Mailing Address - Street 2:STE 201
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2418
Mailing Address - Country:US
Mailing Address - Phone:516-466-4900
Mailing Address - Fax:516-466-4901
Practice Address - Street 1:380 GROVE ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-5503
Practice Address - Country:US
Practice Address - Phone:718-628-5977
Practice Address - Fax:718-628-5978
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004808111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYXOB311Medicare UPIN
NYG400076783Medicare PIN
NYA400073846Medicare PIN
NYX26971Medicare ID - Type Unspecified
NYA400011313Medicare PIN