Healthcare Provider Details

I. General information

NPI: 1588570378
Provider Name (Legal Business Name): NICOLE TCHERNIAVSKI
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7064 YELLOWSTONE BLVD STE D1
FOREST HILLS NY
11375-3564
US

IV. Provider business mailing address

7064 YELLOWSTONE BLVD STE D1
FOREST HILLS NY
11375-3564
US

V. Phone/Fax

Practice location:
  • Phone: 347-783-1818
  • Fax:
Mailing address:
  • Phone: 347-783-1818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number360727
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: