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General NPI Number Information
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NPI Number | 1902445810
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Entity Type | Individual
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Provider Name | ABY GEORGE CHACKO
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Gender | Male
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Dates
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Enumeration Date | 12/26/2019
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 521 BEACH 20TH ST
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-3645
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Country | US
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Telephone | 718-869-8822
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Fax |
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Provider Business Mailing Address
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Address Line | 18 SEITZ DR
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City | BETHPAGE
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State | NY
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Zip | 11714-6017
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Country | US
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Telephone | 443-224-0265
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 100182-01
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License Number State | NY
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