Individual
JESSY CHACKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
300 COMMUNITY DR, MANHASSET, NY 11030-3816
(516) 562-4676
Mailing address
300 COMMUNITY DR, MANHASSET, NY 11030-3816
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
015945
NY
Other
Enumeration date
12/03/2012
Last updated
04/02/2013
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