Provider Demographics
NPI:1902801145
Name:CHERNOV, LEONID (MD)
Entity Type:Individual
Prefix:
First Name:LEONID
Middle Name:
Last Name:CHERNOV
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 1:2310 65TH ST
Mailing Address - Street 2:STE 2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-4089
Mailing Address - Country:US
Mailing Address - Phone:718-998-0100
Mailing Address - Fax:718-998-9239
Practice Address - Street 1:2310 65TH ST
Practice Address - Street 2:STE 2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-4089
Practice Address - Country:US
Practice Address - Phone:718-998-0100
Practice Address - Fax:718-998-9239
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197487207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01667918Medicaid
NYF88721Medicare UPIN
NY01667918Medicaid