Provider Demographics
NPI:1265728398
Name:CHACKO, BINU (MD)
Entity type:Individual
Prefix:
First Name:BINU
Middle Name:
Last Name:CHACKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:366 N BROADWAY
Mailing Address - Street 2:SUITE PH-E1
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2020
Mailing Address - Country:US
Mailing Address - Phone:424-242-2568
Mailing Address - Fax:516-879-3099
Practice Address - Street 1:366 N BROADWAY
Practice Address - Street 2:SUITE PH-E1
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2020
Practice Address - Country:US
Practice Address - Phone:424-242-2568
Practice Address - Fax:516-879-3099
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2614872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry