MEDICARE: DR. ROOSEVELT CHERUBIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	238698	NY

General Provider Information

NPI Number	:	1093767394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROOSEVELT CHERUBIN M.D.

Provider Business Mailing Address
First Line	:	153 EAST MARKET STREET
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-2132
Country	:	US
Telephone Number	:	516-557-8137
Fax Number	:	718-534-5052

Provider Business Practice Location Address
First Line	:	994 NEW YORK AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-3812
Country	:	US
Telephone Number	:	929-234-3700
Fax Number	:	718-534-5052

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	10/10/2025

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