Provider Demographics
NPI:1780746685
Name:EARL L CHERNIAK DPM A PROF CORP
Entity type:Organization
Organization Name:EARL L CHERNIAK DPM A PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EARL
Authorized Official - Middle Name:LOWELL
Authorized Official - Last Name:CHERNIAK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:310-476-5397
Mailing Address - Street 1:11724 GWYNNE LANE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077
Mailing Address - Country:US
Mailing Address - Phone:310-476-5397
Mailing Address - Fax:310-476-8003
Practice Address - Street 1:3984 SO FIGUEROA ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037
Practice Address - Country:US
Practice Address - Phone:213-747-7272
Practice Address - Fax:310-476-8003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1180213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E11800Medicaid
CAT10810Medicare UPIN
CA000E11800Medicaid
CA0269650001Medicare NSC