Individual provider Active NPI

Jefferson Junior Celus Cesar, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Amityville, NY
National Provider Identifier
1568765683
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
402247 Issued in NY
Practice address
400 Sunrise Hwy
Amityville, NY 11701-2508
Phone
(631) 424-7431
NPI assigned
Dec 11, 2010
Last updated
Jun 16, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 634746 NY
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 402247 NY Primary

Addresses

Primary practice location

400 Sunrise Hwy
Amityville, NY 11701-2508

Mailing address

400 Sunrise Hwy
Amityville, NY 11701-2508
Phone (631) 264-4000

Other identifiers 1

IdentifierTypeStateIssuer
04840653MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170908002928 NY Practitioner - Nurse Practitioner 8325311566 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
State University of New York at Stony Brook, School of Medicine, 2017
Medicare assignment
May accept Medicare assignment
Group practices
The Long Island HomeGroup PAC ID 8224055108, 22 clinicians

Practice addresses (Care Compare)

400 Sunrise Hwy
Amityville, NY 11701-2508
Phone (631) 608-5149

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
634746NYMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
The Long Island Home CurrentSince Aug 1, 2017 Accepting new patients
The Long Island Home CurrentSince Aug 1, 2017 Accepting new patients

Locations

400 Sunrise Hwy
Amityville, NY 11701
Phone (631) 264-4000

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1292025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529107200000",
    "number": "1568765683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 SUNRISE HWY",
            "city": "AMITYVILLE",
            "state": "NY",
            "postal_code": "117012508",
            "telephone_number": "631-264-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 SUNRISE HWY",
            "city": "AMITYVILLE",
            "state": "NY",
            "postal_code": "117012508",
            "telephone_number": "631-424-7431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CESAR",
        "first_name": "JEFFERSON",
        "middle_name": "JUNIOR CELUS",
        "name_prefix": "Mr.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-12-11",
        "last_updated": "2018-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "634746",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "402247",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04840653",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Amityville, NY

Sources for this page

Verify at the official NPI Registry.