1902492499 NPI number — BENITA K CHERNYK, PH.D., LLC

Table of content: (NPI 1902492499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902492499 NPI number — BENITA K CHERNYK, PH.D., LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BENITA K CHERNYK, PH.D., LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1902492499
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 202653
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44120-8127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-382-2929
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5005 ROCKSIDE RD
Provider Second Line Business Practice Location Address:
CROWN CENTRE STE 600
Provider Business Practice Location Address City Name:
INDEPENDENCE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44131-6837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-382-2929
Provider Business Practice Location Address Fax Number:
216-465-2829
Provider Enumeration Date:
12/18/2020

Additional Information

Authorized Official

Authorized Official Last Name:
CHERNYK
Authorized Official First Name:
BENITA
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT/ OWNER
Authorized Official Telephone Number:
216-382-2929

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0825727 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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