Provider Demographics
NPI:1013284710
Name:EMPIRE MEDICAL OF ROCKAWAY BEACH
Entity Type:Organization
Organization Name:EMPIRE MEDICAL OF ROCKAWAY BEACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JYOTI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAKOTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-634-8080
Mailing Address - Street 1:8820 ROCKAWAY BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11693-1608
Mailing Address - Country:US
Mailing Address - Phone:718-634-8080
Mailing Address - Fax:718-634-8087
Practice Address - Street 1:8820 ROCKAWAY BEACH BLVD
Practice Address - Street 2:
Practice Address - City:ROCKAWAY BEACH
Practice Address - State:NY
Practice Address - Zip Code:11693-1608
Practice Address - Country:US
Practice Address - Phone:718-634-8080
Practice Address - Fax:718-634-8087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-23
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01780574Medicaid
02940IMedicare PIN