Provider Demographics
NPI:1033267174
Name:CHACHERE, JULIA REBEKAH THEODORA (NP, CNM)
Entity Type:Individual
Prefix:MS
First Name:JULIA
Middle Name:REBEKAH THEODORA
Last Name:CHACHERE
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Gender:F
Credentials:NP, CNM
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Mailing Address - Street 1:PECONIC BAY PRIMARY CARE
Mailing Address - Street 2:P.O. BOX 2377
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901
Mailing Address - Country:US
Mailing Address - Phone:631-298-4479
Mailing Address - Fax:631-259-0298
Practice Address - Street 1:NORTH FORK FAMILY PRACTICE
Practice Address - Street 2:32845 MAIN ROAD
Practice Address - City:CUTCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11935
Practice Address - Country:US
Practice Address - Phone:631-405-3235
Practice Address - Fax:631-259-0298
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2019-08-21
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Provider Licenses
StateLicense IDTaxonomies
NYF001238-1176B00000X
NYF001238176B00000X
NYF420821363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02912783Medicaid