Individual
BENNY T CHACKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
62 BIRCHARD AVE, STATEN ISLAND, NY 10314-4137
(718) 698-4086
Mailing address
62 BIRCHARD AVE, STATEN ISLAND, NY 10314-4137
(718) 698-4086
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
299431-1
NY
Other
Enumeration date
03/26/2010
Last updated
03/26/2010
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