Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | 249237-1 | NY |
N | 2080P0205X | Pediatric Endocrinologist | MD453912 | PA |
NPI | 1407093511 |
---|---|
Provider Name | Dr. Elizabeth Mathews Chacko |
First Address | Woodbury, NY 11797-1116 |
Second Address | New York, NY 10029 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2009 |
Last Update Date | 12/03/2019 |