Basic Information
Provider Information
NPI: 1578655155
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHERNOFF
FirstName: LINDA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 48 ROUTE 25A
Address2: SUITE 101
City: SMITHTOWN
State: NY
PostalCode: 117871431
CountryCode: US
TelephoneNumber: 6318623413
FaxNumber: 6318623604
Practice Location
Address1: 48 ROUTE 25A
Address2: SUITE 101
City: SMITHTOWN
State: NY
PostalCode: 117871431
CountryCode: US
TelephoneNumber: 6318623413
FaxNumber: 6318623604
Other Information
ProviderEnumerationDate: 09/29/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X210808-1NYY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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