1255654141 NPI number — MS. RINSI CHACKO

Table of content: MS. RINSI CHACKO (NPI 1255654141)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255654141 NPI number — MS. RINSI CHACKO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHACKO
Provider First Name:
RINSI
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255654141
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 ANDOVER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYOSSET
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11791-6302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-802-3977
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 SEAVIEW BLVD
Provider Second Line Business Practice Location Address:
GE HEALTHCARE
Provider Business Practice Location Address City Name:
PORT WASHINGTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11050-4618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-626-2799
Provider Business Practice Location Address Fax Number:
516-621-5807
Provider Enumeration Date:
03/05/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  046274 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 183500000X , with the licence number: PS44581 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1835N0905X , with the licence number: 105006799 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)