=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033879937
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBERT KACHKO LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2021
-----------------------------------------------------
Last Update Date | 12/20/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 345 7TH AVE STE 1601
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10001-5006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 929-379-0920
-----------------------------------------------------
Fax | 929-379-0925
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 345 7TH AVE STE 1601
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10001-5006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 929-379-0920
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ROBERT KACHKO
-----------------------------------------------------
Credential | ND, LAC
-----------------------------------------------------
Telephone | 908-216-7480
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------