Individual
DR. MASON CHACKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
101 NICOLLS RD, STONY BROOK, NY 11794-8408
(631) 444-3604
Mailing address
PO BOX 1559, STONY BROOK, NY 11790-0989
(631) 444-3406
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
258527
NY
Other
Enumeration date
09/15/2010
Last updated
02/05/2020
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