| NPI | 1992103352 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY CHACKO President 516-503-6553 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 256586) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: NY 256586) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NY 266586) | |
| Enumeration Date | 2014-12-16 |
| Last Update Date | 2016-11-22 |