Healthcare Provider Details

I. General information

NPI: 1902801145
Provider Name (Legal Business Name): LEONID CHERNOV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 65TH ST STE 2
BROOKLYN NY
11204-4089
US

IV. Provider business mailing address

2310 65TH ST STE 2
BROOKLYN NY
11204-4089
US

V. Phone/Fax

Practice location:
  • Phone: 718-998-0100
  • Fax: 718-998-9239
Mailing address:
  • Phone: 718-998-0100
  • Fax: 718-998-9239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number197487
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: