Provider Demographics
NPI:1871531871
Name:CEPELLOS, VIRGILIO S (MD)
Entity type:Individual
Prefix:DR
First Name:VIRGILIO
Middle Name:S
Last Name:CEPELLOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2322 30TH AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-3255
Mailing Address - Country:US
Mailing Address - Phone:718-267-0332
Mailing Address - Fax:718-267-1990
Practice Address - Street 1:2322 30TH AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-3255
Practice Address - Country:US
Practice Address - Phone:718-267-0332
Practice Address - Fax:718-267-1990
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116870207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00216317Medicaid
NY00216317Medicaid
NY79132Medicare ID - Type Unspecified