Provider Demographics
NPI:1154835957
Name:CHACKO, ANOOP
Entity Type:Individual
Prefix:
First Name:ANOOP
Middle Name:
Last Name:CHACKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7324 YELLOWSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4137
Mailing Address - Country:US
Mailing Address - Phone:718-268-2888
Mailing Address - Fax:718-268-2889
Practice Address - Street 1:3244 31ST ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-2561
Practice Address - Country:US
Practice Address - Phone:718-707-6970
Practice Address - Fax:718-707-6977
Is Sole Proprietor?:No
Enumeration Date:2017-12-01
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042614225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist