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Roger Alejandro Cepeda

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

475 Seaview Ave, Staten Island, NY 10305-3436

PECOS Enrollment

This provider is enrolled in PECOS as ROGER CEPEDA.

Based on the most recent information from CMS, provider Roger Alejandro Cepeda is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 6 days ago.

Profile Details

Provider ID
1114344769
Provider Type
Individual
Full Name
Cepeda, Roger Alejandro
Credential
PA

Gender
Male
Sole Proprietor
Yes
Enumeration Date
3/20/2014
Last Updated
12/10/2019

Contact Information

Practice Location

475 Seaview Ave, Staten Island, NY 10305-3436

(718) 226-1671

Unlisted Fax

Mailing Location

158 Corson Ave, Staten Island, NY 10301-2943

(347) 969-7463

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 23017466 New York
Code 363A00000X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License PA9110264 Florida

Provider Identifiers

ID	Description	Issuer
ID PA9110264	Description Other	Issuer MEDICAL LICENSE Florida

Roger Alejandro Cepeda

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Efendija, Betim

Ginzburg, Anna

Boss, Evelyn

Suarez, Michelle

Cherlenyuk, Yuliya

Scribani, Stephanie Nicole

Datta, Adrienne

Russo, James Vincent

Samuel, Jonathan Hendrickson

Olinsky, Melanie