Individual provider Active NPI

Andrew Jon Chernack, M.D.

  • Family Medicine Physician
  • Poughkeepsie, NY
National Provider Identifier
1972500205
Registry record updated Apr 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
154432 Issued in NY
Practice address
1 Webster Ave
Suite 301
Poughkeepsie, NY 12601-1361
Phone
(845) 790-6100
Fax
(845) 345-9966
NPI assigned
Jul 1, 2005
Reactivated
Apr 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 154432 NY Primary

Addresses

Primary practice location

1 Webster Ave
Suite 301
Poughkeepsie, NY 12601-1361

Mailing address

243 North Rd
Suite 304
Poughkeepsie, NY 12601-1172
Phone (845) 471-9410

Other identifiers 1

IdentifierTypeStateIssuer
01288040MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429747200000",
    "number": "1972500205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "243 NORTH RD",
            "address_2": "SUITE 304",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "126011172",
            "telephone_number": "845-471-9410",
            "fax_number": "845-451-7757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 WEBSTER AVE",
            "address_2": "SUITE 301",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "126011361",
            "telephone_number": "845-790-6100",
            "fax_number": "845-345-9966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHERNACK",
        "first_name": "ANDREW",
        "middle_name": "JON",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-01",
        "last_updated": "2015-04-23",
        "deactivation_date": "2006-03-20",
        "reactivation_date": "2006-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "154432",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01288040",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Poughkeepsie, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.