Physician Compare National (NPI:1700024064)

HEALTHCARE PROVIDER: JEFFREY K CHACKO M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1700024064
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0446396725
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110210000309
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	CHACKO
	Individual professional last name
Provider First Name	JEFFREY
	Individual professional first name
Provider Middle Name	K
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	SOUTHERN CALIFORNIA COLLEGE OF OPTOMETRY
	Individual professional's medical school
Graduation Year	2005
	Individual professional's medical school graduation year
Primary Specialty	PHYSICAL MEDICINE AND REHABILITATION
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	INTERVENTIONAL PAIN MANAGEMENT
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	INTERVENTIONAL PAIN MANAGEMENT
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	8611 LEFFERTS BLVD
	Group Practice or individual's line 1 address
Line 2 Street Address	3B
	Group Practice or individual's line 2 address
City	RICHMOND HILL
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	114182582
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	M