Healthcare Provider Details

I. General information

NPI: 1083998991
Provider Name (Legal Business Name): CHERI JAMISON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2011
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

587 MAIN ST
NEW YORK NY
10044-0096
US

IV. Provider business mailing address

234 W 123RD ST APT G.
NEW YORK NY
10027-5443
US

V. Phone/Fax

Practice location:
  • Phone: 212-223-5055
  • Fax: 212-223-5031
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number791895971
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number765253971
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number763541971
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code235500000X
TaxonomySpeech/Language/Hearing Specialist/Technologist
License Number274705031
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: