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Individual

NINA M CHACKO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
1532 CORLIES AVE, NEPTUNE, NJ 07753-4904
(732) 775-8400
Mailing address
2 CLEARVIEW DRIVE, OCEAN, NJ 07712
(732) 556-7698

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
25MP00312000
NJ

Other

Enumeration date
07/29/2013
Last updated
07/29/2013
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