Provider Demographics
NPI: | 1164887055 |
---|---|
Name: | PATRICK WILLIAM CHERNESKY |
Entity Type: | Organization |
Organization Name: | PATRICK WILLIAM CHERNESKY |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | PATRICK |
Authorized Official - Middle Name: | W |
Authorized Official - Last Name: | CHERNESKY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DPM |
Authorized Official - Phone: | 941-629-1153 |
Mailing Address - Street 1: | PO BOX 510885 |
Mailing Address - Street 2: | |
Mailing Address - City: | PUNTA GORDA |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33951-0885 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4055 TAMIAMI TRL |
Practice Address - Street 2: | STE 9 |
Practice Address - City: | PORT CHARLOTTE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33952-9212 |
Practice Address - Country: | US |
Practice Address - Phone: | 941-629-1153 |
Practice Address - Fax: | 941-629-0104 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-12-21 |
Last Update Date: | 2015-12-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | PO1660 | 213E00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Single Specialty |