Individual
JOSE CERVANTES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
13420 JAMAICA AVE, JAMAICA, NY 11418-2619
(718) 206-6742
(718) 206-6905
Mailing address
80 MARCUS DR, PROVIDER ENROLLMENT, MELVILLE, NY 11747-4230
(631) 391-7889
(631) 454-4161
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
159085
NY
207RH0003X
Hematology & Oncology Physician
Primary
159085
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01013372
—
NY
Enumeration date
04/08/2006
Last updated
01/17/2013
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