Provider Demographics
NPI:1326110883
Name:CHERUBIM, JUSTIN LAWRENCE (DO)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:LAWRENCE
Last Name:CHERUBIM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 PARK AVE # 181
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-2943
Mailing Address - Country:US
Mailing Address - Phone:585-737-9997
Mailing Address - Fax:
Practice Address - Street 1:620 PARK AVE # 181
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-2943
Practice Address - Country:US
Practice Address - Phone:585-737-9997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201105-1207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB39899Medicare UPIN