Provider Demographics
NPI:1073221602
Name:CHERY, GREGORY (OTA)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:CHERY
Suffix:
Gender:M
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2343
Mailing Address - Country:US
Mailing Address - Phone:862-437-3197
Mailing Address - Fax:
Practice Address - Street 1:67 S FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-2015
Practice Address - Country:US
Practice Address - Phone:201-310-9785
Practice Address - Fax:201-338-8370
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09217500224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant