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Individual

MARTIN G CHERNIACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
263 FARMINGTON AVE, FARMINGTON, CT 06030-0001
(860) 679-2893
(860) 679-4587
Mailing address
65 KANE ST, PROVIDER ENROLLMENT, WEST HARTFORD, CT 06119-2110
(860) 523-6421
(860) 523-3701

Taxonomy

Speciality
Code
Description
License number
State
2083P0500X
Preventive Medicine/Occupational Environmental Medicine Physician
Primary
027278
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1272781
CT
Enumeration date
06/22/2005
Last updated
07/11/2022
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