DR. MATHEW MELOOTTU CHACKO (NPI# 1407956907) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407956907 |
| Entity Type | Individual |
| Full Name | DR. MATHEW MELOOTTU CHACKO |
| Credential | MD |
| Practice Address |
222 E Main St Siute 101 Smithtown NY 11787-2871 |
| Practice Telephone | 6313600303 |
| Practice Fax Number | 6313602815 |
| Mailing Telephone | 6313600303 |
| Mailing Fax Number | 6313602815 |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
149174 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 00893614 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750393930 | Mathew Chacko | Internal Medicine | 7101 Jahnke Rd, Suite 611, Richmond, VA 23225-4017 | 2006-08-13 |
| Street Address |
222 E MAIN ST SIUTE 101 |
| City | SMITHTOWN |
| State | NY |
| Zip Code | 11787-2871 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447779186 | Leanna Rose Jenkins | Speech-Language Pathologist | 222 E Main St, Smithtown, NY 11787-2871 | 2017-09-13 |
| 1578847695 | Ashley King Curtis | Nurse Practitioner | 222 E Main St, Suite 111, Smithtown, NY 11787-2871 | 2011-10-07 |
| 1912163346 | Mathew M. Chacko Physician PC | Psychiatry & Neurology | 222 E Main St, Suite 101, Smithtown, NY 11787-2871 | 2008-08-05 |
| 1740498427 | Barton L. Schneyer M.d. P.l.l.c. | Internal Medicine | 222 E Main St, Ste 200, Smithtown, NY 11787-2871 | 2007-05-18 |
| 1104944032 | Dermedx Dermatology PC | Specialist | 222 E Main St, Suite 228, Smithtown, NY 11787-2871 | 2007-03-27 |
| 1285774208 | Stephen Honor | Specialist | 222 E Main St, Suite 215, Smithtown, NY 11787-2871 | 2007-02-07 |
| 1871671909 | Seymour Alter Md | Internal Medicine | 222 E Main St, Suite 109, Smithtown, NY 11787-2871 | 2006-11-02 |
| 1740378520 | Michael Herships | Psychologist | 222 E Main St, Suite 210, Smithtown, NY 11787-2871 | 2006-10-10 |
| 1487761524 | Ronald Braun | Dentist | 222 E Main St, Suite 316, Smithtown, NY 11787-2871 | 2006-08-24 |
| 1467475764 | Robert Peter Morris | Ophthalmology | 222 E Main St, Suite 330, Smithtown, NY 11787-2871 | 2006-07-26 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558962779 | Gwendolyn Burris | Counselor | 20 Gilbert Avenue, Suite 107-a, Smithtown, NY 11787 | 2020-11-04 |
| 1467051193 | Karin M Caro | Adult Companion | 9 Three Pond Road, Smithtown, NY 11787 | 2020-10-23 |
| 1639706641 | Nimit Khara | Student in an Organized Health Care Education/Training Program | 240 Middle Country Rd A, Smithtown, NY 11787 | 2020-03-27 |
| 1003469032 | Maria Teresa Gardella | Nurse Practitioner | St. Catherine of Siena Medical Center, 50 Ny-25a, Smithtown, NY 11787 | 2019-07-18 |
| 1558922070 | Pamella Ann Grillo | Physician Assistant | 373 Ny-111 #5, Smithtown, NY 11787 | 2019-06-25 |
| 1306308127 | Sherry Hansen | Social Worker | 285 Middle Country Rd, Suite Ll5, Smithtown, NY 11787 | 2019-04-01 |
| 1932663747 | Kayla Roundsman | Counselor | 11 Route 11, Smithtown, NY 11787 | 2019-01-25 |
| 1568959856 | Moreen Johnson | Registered Nurse | Christian Nursing Registry, 17 Bank Ave, Smith Town, NY 11787 | 2018-04-23 |
| 1992217871 | Erica Zeller Licensed Clinical Social Work Pllc | Social Worker | 15 Bellemeade Ave Ste 3, Smithtown, NY 11787 | 2017-10-31 |
| 1881117802 | Oisin Vincent Keenan | Case Manager/Care Coordinator | 11 Ny-111, Smithtown, NY 11787 | 2017-07-21 |
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| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255499406 | Harpreet Khurana | Psychiatry & Neurology | 496 Smithtown Bypass, Suite 307, Smithtown, NY 11787-5012 | 2006-12-04 |
| 1467556662 | Schenley H Que | Psychiatry & Neurology | 45 Terry Road, Suite A, Smithtown, NY 11787 | 2006-09-11 |
| 1497392617 | Dr. Jennifer Mcmonigle Medical, P.C. | Psychiatry & Neurology | 1045 W Jericho Tpke, Smithtown, NY 11787-3205 | 2019-12-06 |
| 1033458526 | Reuben David Burshtein | Psychiatry & Neurology | 45 Terry Rd, Ste A, Smithtown, NY 11787-3894 | 2013-02-05 |
| 1598909780 | Mark J. Zuckerman, Physician, P.C. | Psychiatry & Neurology | 363 Route 111, Suite 102, Smithtown, NY 11787-4756 | 2009-05-01 |
| 1912163346 | Mathew M. Chacko Physician PC | Psychiatry & Neurology | 222 E Main St, Suite 101, Smithtown, NY 11787-2871 | 2008-08-05 |
| 1821256595 | Island Comprehensive Neurology LLP | Psychiatry & Neurology | 496 Smithtown Byp, Suite 307, Smithtown, NY 11787-5005 | 2008-05-29 |
| 1790846244 | Mark Julian Zuckerman | Psychiatry & Neurology | 373 Route 111, Suite 20, Smithtown, NY 11787-4759 | 2006-12-12 |
| 1376647578 | Richard A Pearl Md PC | Psychiatry & Neurology | 45 Terry Road, Suite A, Smithtown, NY 11787 | 2006-09-11 |
| 1740384932 | Richard A Pearl | Psychiatry & Neurology | 45 Terry Road, Suite A, Smithtown, NY 11787 | 2006-09-11 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.