Provider Demographics
NPI:1063057347
Name:CHEBOTARU, VIORIKA (PA-C)
Entity type:Individual
Prefix:
First Name:VIORIKA
Middle Name:
Last Name:CHEBOTARU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2644 HARING ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1606
Mailing Address - Country:US
Mailing Address - Phone:201-275-9802
Mailing Address - Fax:
Practice Address - Street 1:626 SHEEPSHEAD BAY RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-3602
Practice Address - Country:US
Practice Address - Phone:718-215-7340
Practice Address - Fax:718-215-7345
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-11
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QU0200X, 363A00000X
NY024463207XX0005X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty