Provider Demographics
NPI:1134271075
Name:CHACHKO, FAINA (MD)
Entity type:Individual
Prefix:DR
First Name:FAINA
Middle Name:
Last Name:CHACHKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 E 55TH ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022
Mailing Address - Country:US
Mailing Address - Phone:212-759-5550
Mailing Address - Fax:212-759-9788
Practice Address - Street 1:305 E 55TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022
Practice Address - Country:US
Practice Address - Phone:212-759-5550
Practice Address - Fax:212-759-9788
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1604162084P0800X, 2084P0804X
NJMA558002084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA62595Medicare UPIN