Provider Demographics
NPI:1992553465
Name:CERINO, ALLYSON TODD I
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:TODD
Last Name:CERINO
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20925 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1453
Mailing Address - Country:US
Mailing Address - Phone:516-849-0871
Mailing Address - Fax:
Practice Address - Street 1:20925 18TH AVE
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-1453
Practice Address - Country:US
Practice Address - Phone:516-849-0871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY862479174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist