Provider Demographics
NPI:1255654141
Name:CHACKO, RINSI
Entity Type:Individual
Prefix:MS
First Name:RINSI
Middle Name:
Last Name:CHACKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 ANDOVER DR
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-6302
Mailing Address - Country:US
Mailing Address - Phone:516-802-3977
Mailing Address - Fax:
Practice Address - Street 1:80 SEAVIEW BLVD
Practice Address - Street 2:GE HEALTHCARE
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-4618
Practice Address - Country:US
Practice Address - Phone:516-626-2799
Practice Address - Fax:516-621-5807
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046274183500000X
FLPS44581183500000X
MD1050067991835N0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835N0905XPharmacy Service ProvidersPharmacistNuclear