Provider Demographics
NPI:1366954422
Name:CHERIAN, CHRISTI VANNILAM (PA)
Entity type:Individual
Prefix:
First Name:CHRISTI
Middle Name:VANNILAM
Last Name:CHERIAN
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Gender:
Credentials:PA
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Mailing Address - Street 1:700 HICKSVILLE RD STE 205
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-3472
Mailing Address - Country:US
Mailing Address - Phone:267-339-7843
Mailing Address - Fax:718-220-2826
Practice Address - Street 1:1111 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1617
Practice Address - Country:US
Practice Address - Phone:516-535-1900
Practice Address - Fax:516-535-1905
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-30
Last Update Date:2025-04-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY022279363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty