Provider Demographics
NPI:1407093511
Name:CHACKO, ELIZABETH MATHEWS (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:MATHEWS
Last Name:CHACKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:MATHEWS
Other - Last Name:THURUTHEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2 CLEARMEADOW LN
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-1116
Mailing Address - Country:US
Mailing Address - Phone:516-603-9061
Mailing Address - Fax:
Practice Address - Street 1:5 EAST 98TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029
Practice Address - Country:US
Practice Address - Phone:212-241-8210
Practice Address - Fax:484-664-7864
Is Sole Proprietor?:No
Enumeration Date:2009-01-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4539122080P0205X
NY249237-12080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology