Provider Demographics
NPI:1972500205
Name:CHERNACK, ANDREW JON (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JON
Last Name:CHERNACK
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 1:243 NORTH RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1172
Mailing Address - Country:US
Mailing Address - Phone:845-471-9410
Mailing Address - Fax:845-451-7757
Practice Address - Street 1:1 WEBSTER AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1361
Practice Address - Country:US
Practice Address - Phone:845-790-6100
Practice Address - Fax:845-345-9966
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2015-04-23
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
NY154432207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01288040Medicaid
NY01288040Medicaid
A400064020Medicare PIN