Individual
VIJU CHACKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
140 OLD ORANGEBURG RD, ORANGEBURG, NY 10962-1157
(845) 680-8600
Mailing address
16 BRADL LN, NANUET, NY 10954-3130
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
553736
NY
Other
Enumeration date
06/03/2024
Last updated
06/03/2024
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