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Provider Information for 1134125529

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

MARTIN G CHERNIACK MD

Gender: MALE

Individual NPI: 1134125529

Calendar   Last Updated:  2010-04-15
  Certification Date: 

Details

Name Value
NPI 1134125529
Enumeration Date 2005-06-22
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 65 KANE ST PROVIDER ENROLLMENT
WEST HARTFORD, CT 06119-2110
United States

Phone: 860-523-6421 | Fax: 860-523-3701
View Map External Link
Primary Practice Address 263 FARMINGTON AVE
FARMINGTON, CT 06030-0001
United States

Phone: 860-679-2893 | Fax: 860-679-4587
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
MEDICAID CT 1272781
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 2083P0500X - Preventive Medicine Preventive Medicine/Occupational Environmental Medicine CT 027278