National Provider Identifier
Justin Elijah Moroscallo Cerdena, PA-C
Justin Elijah Moroscallo Cerdena, PA-C is listed in the NPPES registry with a primary specialty of Physician Assistant in Ithaca, NY and a listed phone number of (607) 274-3011.
Profile Overview
- NPI
- 1215703699
- Provider Type
- Individual
- Primary Specialty
- Physician Assistant
- Enumeration Date
- November 28, 2023
- Last Updated
- November 28, 2023
Practice Location
- 215 E State St
- Ithaca, NY 14850-5547
Phone: (607) 274-3011
Specialties
- Physician Assistant (363A00000X)
Full Record
- NPI
- 1215703699
- Entity Type
- Individual
- Last Name
- Cerdena
- First Name
- Justin
- Middle Name
- Elijah Moroscallo
- Credential
- PA-C
- Mailing Street Address
- 215 E State St
- Mailing City
- Ithaca
- Mailing State
- NY
- Mailing ZIP Code
- 14850-5547
- Mailing Country
- US
- Practice Street Address
- 215 E State St
- Practice City
- Ithaca
- Practice State
- NY
- Practice ZIP Code
- 14850-5547
- Practice Country
- US
- Practice Phone
- (607) 274-3011
- Enumeration Date
- November 28, 2023
- Last Updated
- November 28, 2023
- Sex
- Male
- Sole Proprietor
- No
- Certification Date
- November 28, 2023
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Physician Assistant (363A00000X)