Provider Demographics
NPI:1255833109
Name:CHERTKOVSKY, ANTON (PA)
Entity Type:Individual
Prefix:
First Name:ANTON
Middle Name:
Last Name:CHERTKOVSKY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3045 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRAL SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:13036-2611
Mailing Address - Country:US
Mailing Address - Phone:315-668-5212
Mailing Address - Fax:
Practice Address - Street 1:3045 EAST AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL SQUARE
Practice Address - State:NY
Practice Address - Zip Code:13036
Practice Address - Country:US
Practice Address - Phone:315-668-5212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant