Provider Demographics
NPI:1699874487
Name:DYAL, CHERISE (MD)
Entity type:Individual
Prefix:DR
First Name:CHERISE
Middle Name:
Last Name:DYAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1777 HAMBURG TPKE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-5211
Mailing Address - Country:US
Mailing Address - Phone:973-839-5700
Mailing Address - Fax:973-616-4343
Practice Address - Street 1:1777 HAMBURG TPKE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-5211
Practice Address - Country:US
Practice Address - Phone:973-839-5700
Practice Address - Fax:973-616-4343
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07083800207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ578951OtherEMPIRE
NJ61928OtherOPERATING LOCAL
NJ8311901Medicaid
NY10477971OtherMASTERCARE
NJ1127396OtherHORIZON
NJ126372OtherCHN
NJ223338995OtherTAX ID
NJ19Q541OtherEMPIRE
NJ1K6476OtherHEALTHNET
NJ2355795OtherAETNA
NJ1356408OtherUNITED HEALTHCARE
NJ1808825OtherFIRST HEALTH
NJ599351OtherGHI
NJP837925OtherOXFORD
NJ10477973OtherMAASTERCARE
NJ223338995OtherFOCUS
NJ1808825OtherFIRST HEALTH
NJ040251Medicare ID - Type Unspecified