Provider Demographics
NPI:1386019305
Name:VCHERASHANSKY, LUBA
Entity Type:Individual
Prefix:
First Name:LUBA
Middle Name:
Last Name:VCHERASHANSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11314 72ND RD
Mailing Address - Street 2:#4E
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4657
Mailing Address - Country:US
Mailing Address - Phone:917-572-8975
Mailing Address - Fax:
Practice Address - Street 1:11314 72ND RD
Practice Address - Street 2:#4E
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4657
Practice Address - Country:US
Practice Address - Phone:917-572-8975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist