Individual
MR. JERRIN CHACKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
8900 VAN WYCK EXPY, RICHMOND HILL, NY 11418-2832
(718) 206-6000
Mailing address
8624 MUSKET ST, QUEENS VILLAGE, NY 11427-2718
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
403669
NY
Other
Enumeration date
08/26/2021
Last updated
08/26/2021
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