Healthcare Provider Details

I. General information

NPI: 1083859664
Provider Name (Legal Business Name): SONYA TCHEREVKOFF OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SONYA TCHEREVKOFF OTR/L

II. Dates (important events)

Enumeration Date: 12/10/2008
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date: 02/11/2019
Reactivation Date: 07/09/2026

III. Provider practice location address

156 PINE ST
JERSEY CITY NJ
07304-3303
US

IV. Provider business mailing address

156 PINE ST
JERSEY CITY NJ
07304-3303
US

V. Phone/Fax

Practice location:
  • Phone: 917-699-7838
  • Fax:
Mailing address:
  • Phone: 917-699-7838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR00658300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number014213-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: