1235138439 NPI number — DR. PASCALE R CHERY DMD

Table of content: DR. PASCALE R CHERY DMD (NPI 1235138439)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235138439 NPI number — DR. PASCALE R CHERY DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHERY
Provider First Name:
PASCALE
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

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:
1235138439
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 S WOODLAND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINTER GARDEN
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34787-3546
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-905-8827
Provider Business Mailing Address Fax Number:
407-209-3221

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4562 ROUTE 9 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOWELL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07731-3771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-474-6500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/19/2005

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: 122300000X , with the licence number:  DN16298 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: DN16298 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 22DI02175700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 075837000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9013407 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 075837000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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