Provider Demographics
NPI:1063507960
Name:CHERNICK, STEPHEN B (DPM)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:B
Last Name:CHERNICK
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:175 FULTON AVE
Mailing Address - Street 2:STE 210
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-3702
Mailing Address - Country:US
Mailing Address - Phone:718-793-3223
Mailing Address - Fax:718-793-0838
Practice Address - Street 1:11247 QUEENS BLVD
Practice Address - Street 2:SUITE 104/105
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7417
Practice Address - Country:US
Practice Address - Phone:718-793-3223
Practice Address - Fax:718-793-0838
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2017-01-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY003399213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00763786Medicaid
NYT32084Medicare UPIN
NY00763786Medicaid