Provider Demographics
NPI:1013953660
Name:CHERNOFF, BRIAN H (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:H
Last Name:CHERNOFF
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 1:935 KINGS HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:WEST DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08086-2238
Mailing Address - Country:US
Mailing Address - Phone:856-845-0664
Mailing Address - Fax:856-845-7602
Practice Address - Street 1:935 KINGS HWY STE 100
Practice Address - Street 2:
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08086-2238
Practice Address - Country:US
Practice Address - Phone:856-845-0664
Practice Address - Fax:856-845-7602
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06460700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G05883Medicare UPIN
NJ776851Medicare PIN