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General NPI Number Information
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NPI Number | 1780093153
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Entity Type | Organization
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Legal Business Name | 84 STREET MEDICAL PC
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Dates
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Enumeration Date | 08/10/2014
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Last Update Date | 08/10/2014
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Provider Practice Location Address
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Address Line | 3559 84TH ST
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-5367
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Country | US
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Telephone | 718-507-0300
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Fax | 718-507-0330
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Provider Business Mailing Address
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Address Line | 1324 E 53RD ST
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City | BROOKLYN
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State | NY
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Zip | 11234-2312
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Country | US
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Telephone | 917-331-8817
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Fax | 718-507-0330
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. LUCOT CHERENFANT
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Credential | M.D.
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Telephone | 718-507-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 244586
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License Number State | NY
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