Provider Demographics
NPI:1043232234
Name:CHERRY, LANCE ELLIOT (MPT)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:ELLIOT
Last Name:CHERRY
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 E 50TH ST
Mailing Address - Street 2:APT. 5A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-7682
Mailing Address - Country:US
Mailing Address - Phone:212-750-0460
Mailing Address - Fax:
Practice Address - Street 1:33 IRVING PL
Practice Address - Street 2:9TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2332
Practice Address - Country:US
Practice Address - Phone:212-677-3989
Practice Address - Fax:212-677-3994
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012671225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ86781Medicare ID - Type Unspecified