Provider Demographics
NPI:1801863048
Name:CHERVENAK, DONALD MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:MICHAEL
Last Name:CHERVENAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1346
Mailing Address - Country:US
Mailing Address - Phone:973-822-3879
Mailing Address - Fax:973-822-0850
Practice Address - Street 1:15 JAMES ST
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1346
Practice Address - Country:US
Practice Address - Phone:973-822-3879
Practice Address - Fax:973-822-0850
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NJ39327207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJB13575Medicare UPIN
NJ456598Medicare ID - Type Unspecified