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General NPI Number Information
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NPI Number | 1992103352
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Entity Type | Organization
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Legal Business Name | PRECISION PAIN CARE AND REHABILITATION P.C.
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Dates
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Enumeration Date | 12/16/2014
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Last Update Date | 11/22/2016
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Provider Practice Location Address
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Address Line | 1300 UNION TPKE SUITE 203
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-1764
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Country | US
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Telephone | 516-503-6553
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Fax | 718-215-1889
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Provider Business Mailing Address
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Address Line | 1300 UNION TPKE SUITE 203
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-1764
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Country | US
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Telephone | 516-503-6553
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Fax | 718-215-1889
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFREY CHACKO
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Credential | M.D.
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Telephone | 516-503-6553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 256586
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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 | 266586
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 256586
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License Number State | NY
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