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General NPI Number Information
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NPI Number | 1700024064
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Entity Type | Individual
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Provider Name | JEFFREY K CHACKO M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/25/2009
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Last Update Date | 02/13/2024
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Provider Practice Location Address
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Address Line | 1300 UNION TPKE STE 203
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-1759
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Country | US
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Telephone | 516-419-4480
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Fax |
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Provider Business Mailing Address
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Address Line | 1300 UNION TPKE STE 203
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-1759
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Country | US
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Telephone | 516-419-4480
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | A256586-01
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 256586
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 256586
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License Number State | NY
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