Healthcare Provider Details

I. General information

NPI: 1275716631
Provider Name (Legal Business Name): CHERRILINE WILLIAMS-WEST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2007
Last Update Date: 12/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3459 EASTCHESTER RD 6-C
BRONX NY
10469-1626
US

IV. Provider business mailing address

3459 EASTCHESTER RD 6-C
BRONX NY
10469-1626
US

V. Phone/Fax

Practice location:
  • Phone: 917-361-3048
  • Fax:
Mailing address:
  • Phone: 917-361-3048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC3500X
TaxonomyCardiac Rehabilitation Registered Nurse
License Number558808-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: