Healthcare Provider Details

I. General information

NPI: 1043758865
Provider Name (Legal Business Name): YURY CHERKASSKY RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2017
Last Update Date: 02/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 AVENUE X
BROOKLYN NY
11223-6008
US

IV. Provider business mailing address

53 HUNTON ST
STATEN ISLAND NY
10304-3101
US

V. Phone/Fax

Practice location:
  • Phone: 718-376-6500
  • Fax: 718-376-5078
Mailing address:
  • Phone: 718-938-9915
  • Fax: 718-376-5078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License Number004647-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: