Provider Demographics
NPI:1235150020
Name:CHERELLA, MICHAEL JOHN (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOHN
Last Name:CHERELLA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:JOHN
Other - Last Name:CHERELLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:175 W COHAWKIN RD STE C
Mailing Address - Street 2:
Mailing Address - City:CLARKSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08020-1145
Mailing Address - Country:US
Mailing Address - Phone:856-423-7700
Mailing Address - Fax:856-423-0823
Practice Address - Street 1:53 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-9701
Practice Address - Country:US
Practice Address - Phone:856-223-9939
Practice Address - Fax:856-223-0327
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003715L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01488481Medicaid
PA01488481Medicaid
PA749772JO4Medicare PIN