Provider Demographics
NPI:1780093153
Name:84 STREET MEDICAL PC
Entity type:Organization
Organization Name:84 STREET MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCOT
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERENFANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-507-0300
Mailing Address - Street 1:1324 E 53RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-2312
Mailing Address - Country:US
Mailing Address - Phone:917-331-8817
Mailing Address - Fax:718-507-0330
Practice Address - Street 1:3559 84TH ST
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-5367
Practice Address - Country:US
Practice Address - Phone:718-507-0300
Practice Address - Fax:718-507-0330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-10
Last Update Date:2014-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244586207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty