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General NPI Number Information
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NPI Number | 1063177814
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Entity Type | Individual
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Provider Name | PETER IAN CHERNACK MSW, LCSW-R, DSW
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Gender | Male
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Dates
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Enumeration Date | 11/06/2021
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Last Update Date | 11/06/2021
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Provider Practice Location Address
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Address Line | 226 E 52ND ST
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City | NEW YORK
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State | NY
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Zip | 10022-6201
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Country | US
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Telephone | 212-712-8800
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Fax |
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Provider Business Mailing Address
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Address Line | 4550 PEARSON ST APT 7K
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City | LONG ISLAND CITY
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State | NY
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Zip | 11101-4367
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Country | US
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Telephone | 516-241-1297
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 025966
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License Number State | NY
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