Healthcare Provider Details

I. General information

NPI: 1992103352
Provider Name (Legal Business Name): PRECISION PAIN CARE AND REHABILITATION P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2014
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 UNION TPKE SUITE 203
NEW HYDE PARK NY
11040-1764
US

IV. Provider business mailing address

1300 UNION TPKE SUITE 203
NEW HYDE PARK NY
11040-1764
US

V. Phone/Fax

Practice location:
  • Phone: 516-503-6553
  • Fax: 718-215-1889
Mailing address:
  • Phone: 516-503-6553
  • Fax: 718-215-1889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number256586
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number256586
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number266586
License Number StateNY

VIII. Authorized Official

Name: DR. JEFFREY CHACKO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 516-503-6553