Healthcare Provider Details

I. General information

NPI: 1902089402
Provider Name (Legal Business Name): EMPIRE MEDICAL OF ROCKAWAY BEACH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2007
Last Update Date: 01/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8820 ROCKAWAY BEACH BLVD
ROCKAWAY BEACH NY
11693-1608
US

IV. Provider business mailing address

8820 ROCKAWAY BEACH BLVD
ROCKAWAY BEACH NY
11693-1608
US

V. Phone/Fax

Practice location:
  • Phone: 718-634-8080
  • Fax: 718-634-8087
Mailing address:
  • Phone: 718-634-8080
  • Fax: 718-634-8087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. VAIJINATH M CHAKOTE
Title or Position: DOCTOR
Credential: MD
Phone: 718-634-8080