Provider Demographics
NPI:1992103352
Name:PRECISION PAIN CARE AND REHABILITATION P.C.
Entity type:Organization
Organization Name:PRECISION PAIN CARE AND REHABILITATION P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHACKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-503-6553
Mailing Address - Street 1:1300 UNION TPKE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1764
Mailing Address - Country:US
Mailing Address - Phone:516-503-6553
Mailing Address - Fax:718-215-1889
Practice Address - Street 1:1300 UNION TPKE
Practice Address - Street 2:SUITE 203
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1764
Practice Address - Country:US
Practice Address - Phone:516-503-6553
Practice Address - Fax:718-215-1889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-16
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY256586208100000X, 208VP0000X
NY266586208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty