Provider Demographics
NPI:1477157113
Name:LERNER, CHANA RIVKA
Entity Type:Individual
Prefix:
First Name:CHANA
Middle Name:RIVKA
Last Name:LERNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHANA
Other - Middle Name:RIVKA
Other - Last Name:DIAMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8 RIVERGLEN DR
Mailing Address - Street 2:
Mailing Address - City:THIELLS
Mailing Address - State:NY
Mailing Address - Zip Code:10984-1436
Mailing Address - Country:US
Mailing Address - Phone:401-965-1791
Mailing Address - Fax:
Practice Address - Street 1:8 RIVERGLEN DR
Practice Address - Street 2:
Practice Address - City:THIELLS
Practice Address - State:NY
Practice Address - Zip Code:10984-1436
Practice Address - Country:US
Practice Address - Phone:401-965-1791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1445600201174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY745346504-00Medicaid