1063177814 NPI number — DR. PETER IAN CHERNACK MSW, LCSW-R, DSW

Table of content: DR. PETER IAN CHERNACK MSW, LCSW-R, DSW (NPI 1063177814)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063177814 NPI number — DR. PETER IAN CHERNACK MSW, LCSW-R, DSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHERNACK
Provider First Name:
PETER
Provider Middle Name:
IAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW-R, DSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063177814
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4550 PEARSON ST APT 7K
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONG ISLAND CITY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11101-4367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-241-1297
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
226 E 52ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10022-6201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-712-8800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/06/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  025966 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com