Provider Demographics
NPI:1063805570
Name:CHERY, MARIE EDLY
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:EDLY
Last Name:CHERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 E 20TH ST
Mailing Address - Street 2:4C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-1519
Mailing Address - Country:US
Mailing Address - Phone:917-471-4309
Mailing Address - Fax:
Practice Address - Street 1:628 E 20TH ST
Practice Address - Street 2:4C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-1519
Practice Address - Country:US
Practice Address - Phone:917-471-4309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-08
Last Update Date:2015-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY321007-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse