Provider Demographics
NPI:1285736496
Name:CHERESKIN, MARY JOSEPHINE (APRNBC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:JOSEPHINE
Last Name:CHERESKIN
Suffix:
Gender:F
Credentials:APRNBC
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:JOSEPHINE
Other - Last Name:RADECKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:11 ALFRED LN
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-5012
Mailing Address - Country:US
Mailing Address - Phone:631-269-1030
Mailing Address - Fax:631-266-6040
Practice Address - Street 1:79 MIDDLEVILLE RD
Practice Address - Street 2:(118)
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-2200
Practice Address - Country:US
Practice Address - Phone:631-261-4400
Practice Address - Fax:631-266-6401
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY266603163W00000X
NY364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health