Individual
DR. MATHEW MELOOTTU CHACKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
222 E MAIN ST, SIUTE 101, SMITHTOWN, NY 11787-2871
(631) 360-0303
(631) 360-2815
Mailing address
222 E MAIN ST, SIUTE 101, SMITHTOWN, NY 11787-2871
(631) 360-0303
(631) 360-2815
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
149174
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00893614
—
NY
Enumeration date
09/24/2006
Last updated
07/08/2007
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