Provider Demographics
NPI:1386717361
Name:CHERON, FRED (MD)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:
Last Name:CHERON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W 106TH ST
Mailing Address - Street 2:MEDICAL DEPARTMENT
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-3712
Mailing Address - Country:US
Mailing Address - Phone:212-870-5000
Mailing Address - Fax:212-870-4905
Practice Address - Street 1:120 W 106TH ST
Practice Address - Street 2:MEDICAL DEPARTMENT
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-3712
Practice Address - Country:US
Practice Address - Phone:212-870-5000
Practice Address - Fax:212-870-4905
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198531207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY94S451Medicare ID - Type UnspecifiedMEDICARE NUMBER
H99781Medicare UPIN