1568472645 NPI number — MRS. RELLY CHERN MD

Table of content: MRS. RELLY CHERN MD (NPI 1568472645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568472645 NPI number — MRS. RELLY CHERN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHERN
Provider First Name:
RELLY
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1568472645
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
923 FIFTH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-628-0160
Provider Business Mailing Address Fax Number:
212-861-8906

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
923 FIFTH AVE
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:
10021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-628-0160
Provider Business Practice Location Address Fax Number:
212-861-8906
Provider Enumeration Date:
08/09/2006

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: 207W00000X , with the licence number:  132063 , 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)

  • Identifier: 00479525 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 26097P . This is a "HIP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0023331 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 132063A19 . This is a "HEALTH FIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 132063 . This is a "LICENSE #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 169047 . This is a "ELDER PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 392536 . This is a "CONECTICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: MC442181181 . This is a "RAILROAD #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4329619 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P450820 . This is a "OXFORD #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 06013WCCO13206 . This is a "SPECTERA #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 35721 . This is a "USH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3C8147 . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 403912 . This is a "UNITED" identifier . This identifiers is of the category "OTHER".




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