Provider Demographics
NPI:1558421057
Name:CHERNILAS, JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:CHERNILAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:
Other - Last Name:CHERNILAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8 VILLAGE GREEN DR
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-4501
Mailing Address - Country:US
Mailing Address - Phone:631-474-1545
Mailing Address - Fax:631-474-5549
Practice Address - Street 1:CARDIOLOGY DIVISION
Practice Address - Street 2:HSC-T-16 R-080 SUNY
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-444-1064
Practice Address - Fax:631-444-1054
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY158058207RC0000X
MA47184207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA38411Medicare UPIN