Provider Demographics
NPI:1447536347
Name:CHERIAN, REBOY (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:REBOY
Middle Name:
Last Name:CHERIAN
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 BATH AVE
Mailing Address - Street 2:UNIT 11
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-6176
Mailing Address - Country:US
Mailing Address - Phone:732-222-5942
Mailing Address - Fax:
Practice Address - Street 1:274 BATH AVE
Practice Address - Street 2:UNIT 11
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-6176
Practice Address - Country:US
Practice Address - Phone:732-222-5942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00269700363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant