Chacko, Lissiamma
Chacko, Lissiamma is an individual health care provider with primary practice located at 18005 Hillside Ave , Jamaica NY 11432-4727. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Chacko, Lissiamma can be contacted via phone (718) 262-6300.Contact Information
Primary practice address
18005 Hillside Ave
Jamaica NY 11432-4727
Phone: (718) 262-6300
Fax: (718) 262-7045
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 128491 | New York |
Profile Details
| NPI number | 1134167919 |
|---|---|
| LBN Legal business name | Chacko, Lissiamma |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 3rd, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1134167919 | NPPES |
| New York | MEDICAID | 00237696 |
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