Healthcare Provider Details

I. General information

NPI: 1578426938
Provider Name (Legal Business Name): JOHN CHERRY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74-03 COMMONWEALTH BLVD, BELLEROSE, NY 11426
QUEENS NY
11426
US

IV. Provider business mailing address

40 RICHMAN PLZ APT 2G
BRONX NY
10453-6406
US

V. Phone/Fax

Practice location:
  • Phone: 718-264-4500
  • Fax:
Mailing address:
  • Phone: 347-323-4939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN10904
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: