Healthcare Provider Details

I. General information

NPI: 1134194426
Provider Name (Legal Business Name): ANIE A CHERIAN D.P.M P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 RICHMOND AVE
STATEN ISLAND NY
10314-3907
US

IV. Provider business mailing address

PO BOX 20280
STATEN ISLAND NY
10302-0280
US

V. Phone/Fax

Practice location:
  • Phone: 917-816-5078
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberN005013
License Number StateNY

VIII. Authorized Official

Name: ANIE A CHERIAN
Title or Position: SOLE PROPRIETER
Credential: D.P.M.
Phone: 917-816-5078