Provider Demographics
NPI:1598112690
Name:CHEREBIN, CARELLE AKILAH (DO)
Entity Type:Individual
Prefix:
First Name:CARELLE
Middle Name:AKILAH
Last Name:CHEREBIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 SUNRISE CT APT 4
Mailing Address - Street 2:
Mailing Address - City:MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11955-2019
Mailing Address - Country:US
Mailing Address - Phone:917-533-0077
Mailing Address - Fax:
Practice Address - Street 1:147 BEACH RD (AT MONTAUK HIGHWAY)
Practice Address - Street 2:
Practice Address - City:WESTHAMPTON BEACH
Practice Address - State:NY
Practice Address - Zip Code:11978-1733
Practice Address - Country:US
Practice Address - Phone:631-288-7746
Practice Address - Fax:631-288-7111
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305159207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine