Provider Demographics
NPI:1164887055
Name:PATRICK WILLIAM CHERNESKY
Entity type:Organization
Organization Name:PATRICK WILLIAM CHERNESKY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHERNESKY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:941-629-1153
Mailing Address - Street 1:PO BOX 510885
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33951-0885
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4055 TAMIAMI TRL
Practice Address - Street 2:STE 9
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-9212
Practice Address - Country:US
Practice Address - Phone:941-629-1153
Practice Address - Fax:941-629-0104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1660213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty