Provider Demographics
NPI:1528174414
Name:LUCIEN M CESIANO MD PC
Entity type:Organization
Organization Name:LUCIEN M CESIANO MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUCIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYER-CESIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-567-5555
Mailing Address - Street 1:4523 BROADWAY
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-2415
Mailing Address - Country:US
Mailing Address - Phone:212-567-5555
Mailing Address - Fax:212-567-5588
Practice Address - Street 1:4523 BROADWAY
Practice Address - Street 2:SUITE 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-2415
Practice Address - Country:US
Practice Address - Phone:212-567-5555
Practice Address - Fax:212-567-5588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA32610207W00000X
FLME23487207W00000X
CAG27338207W00000X
NY106187207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03183653Medicaid
B19668Medicare UPIN
NYWZT2N1Medicare PIN