Provider Demographics
NPI:1962936989
Name:JEAN-PHILIPPE, CHERLINE
Entity type:Individual
Prefix:
First Name:CHERLINE
Middle Name:
Last Name:JEAN-PHILIPPE
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 1:13143 224TH ST
Mailing Address - Street 2:
Mailing Address - City:LAURELTON
Mailing Address - State:NY
Mailing Address - Zip Code:11413-1727
Mailing Address - Country:US
Mailing Address - Phone:917-400-7366
Mailing Address - Fax:
Practice Address - Street 1:13143 224TH ST
Practice Address - Street 2:
Practice Address - City:LAURELTON
Practice Address - State:NY
Practice Address - Zip Code:11413-1727
Practice Address - Country:US
Practice Address - Phone:917-400-7366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONE171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator