Healthcare Provider Details

I. General information

NPI: 1093418972
Provider Name (Legal Business Name): STEVEN CHACKO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 NICOLLS RD
STONY BROOK NY
11794-8434
US

IV. Provider business mailing address

101 NICOLLS RD
STONY BROOK NY
11794-8434
US

V. Phone/Fax

Practice location:
  • Phone: 631-638-2698
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number343949
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: