Provider Demographics
NPI:1659490118
Name:CHEREZOVA, DIANA (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:CHEREZOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:97-77 QUUENS BLVD
Mailing Address - Street 2:9 FL
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374
Mailing Address - Country:US
Mailing Address - Phone:718-267-2440
Mailing Address - Fax:718-267-2445
Practice Address - Street 1:97-77 QUUENS BLVD
Practice Address - Street 2:9 FL
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374
Practice Address - Country:US
Practice Address - Phone:718-267-2440
Practice Address - Fax:718-267-2445
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY214425207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH23146Medicare UPIN