Provider Demographics
NPI:1225226756
Name:CHERNOGLAZ, INNA (PA)
Entity Type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:CHERNOGLAZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1632 E 16TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1108
Mailing Address - Country:US
Mailing Address - Phone:718-336-0330
Mailing Address - Fax:718-336-0073
Practice Address - Street 1:1632 E 16TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1108
Practice Address - Country:US
Practice Address - Phone:718-336-0330
Practice Address - Fax:718-336-0073
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2013-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011714363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical