Provider Demographics
NPI:1124162672
Name:SCHERICK, KENNETH JAY (OD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:JAY
Last Name:SCHERICK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4859
Mailing Address - Country:US
Mailing Address - Phone:212-686-1653
Mailing Address - Fax:212-686-1654
Practice Address - Street 1:608 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4859
Practice Address - Country:US
Practice Address - Phone:212-686-1653
Practice Address - Fax:212-686-1654
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003290-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300027245Medicare PIN
NY6473590001Medicare NSC
NYC25131Medicare PIN