Provider Demographics
NPI:1134760648
Name:CHERPAK, MARGARET MARY (NP)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:MARY
Last Name:CHERPAK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 CLIFF RD
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-1033
Mailing Address - Country:US
Mailing Address - Phone:315-982-3457
Mailing Address - Fax:
Practice Address - Street 1:66 CLIFF RD
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1033
Practice Address - Country:US
Practice Address - Phone:315-982-3457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-05
Last Update Date:2019-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309354363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty