Provider Demographics
NPI:1043349145
Name:CESARIO, LINDA (DPM)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:CESARIO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-1630
Mailing Address - Country:US
Mailing Address - Phone:973-239-9884
Mailing Address - Fax:973-239-9105
Practice Address - Street 1:685 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-1630
Practice Address - Country:US
Practice Address - Phone:973-239-9884
Practice Address - Fax:973-239-9105
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00214100213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ742840Medicare ID - Type Unspecified
NJU41901Medicare UPIN