Provider Demographics
NPI:1063577609
Name:CHEREN, ISABEL (ANP ADULT NURSE PRAC)
Entity type:Individual
Prefix:MS
First Name:ISABEL
Middle Name:
Last Name:CHEREN
Suffix:
Gender:F
Credentials:ANP ADULT NURSE PRAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 HENRY HUDSON PKWY
Mailing Address - Street 2:#203
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10471
Mailing Address - Country:US
Mailing Address - Phone:718-549-5764
Mailing Address - Fax:
Practice Address - Street 1:1711 MORRIS AVENUE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457
Practice Address - Country:US
Practice Address - Phone:718-579-2645
Practice Address - Fax:718-579-2644
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3003401363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02266755Medicaid
NY02266755Medicaid