Provider Demographics
NPI:1902874399
Name:ARBOLEDA, CECILIA TESORO (MD)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:TESORO
Last Name:ARBOLEDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 ALBANY POST RD
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-3601
Mailing Address - Country:US
Mailing Address - Phone:845-229-0790
Mailing Address - Fax:845-229-1749
Practice Address - Street 1:4305 ALBANY POST RD
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-3601
Practice Address - Country:US
Practice Address - Phone:845-229-0790
Practice Address - Fax:845-229-1749
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117294207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00435667Medicaid
117023OtherMVP
117023OtherMVP
290671Medicare ID - Type Unspecified