Individual
MINI CHACKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NNP
Contact information
Practice address
94 OLD SHORT HILLS RD, LIVINGSTON, NJ 07039-5672
(973) 322-5000
Mailing address
8 EDGEMERE RD, LIVINGSTON, NJ 07039-2807
(973) 992-5247
Taxonomy
Speciality
Code
Description
License number
State
363LN0005X
Critical Care Neonatal Nurse Practitioner
Primary
26NJ00655400
NJ
Other
Enumeration date
08/29/2016
Last updated
08/29/2016
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