Individual
JIJIN THOMAS CHACKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
315 S MANNING BLVD, ALBANY, NY 12208-1707
(518) 525-1550
Mailing address
PO BOX 14890, ALBANY, NY 12212-4890
(518) 525-5634
(518) 649-4094
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
25MA09575200
NJ
208M00000X
Hospitalist Physician
Primary
291830
NY
Other
Enumeration date
06/02/2011
Last updated
05/12/2021
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