Provider Demographics
NPI:1447746946
Name:CHARLES, CHERUBIN LUDERS
Entity Type:Individual
Prefix:
First Name:CHERUBIN
Middle Name:LUDERS
Last Name:CHARLES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-1925
Mailing Address - Country:US
Mailing Address - Phone:631-575-9096
Mailing Address - Fax:
Practice Address - Street 1:195 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-1925
Practice Address - Country:US
Practice Address - Phone:631-575-9096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-08
Last Update Date:2018-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY545578-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty