Mini Chacko, NNP

Primary specialty

Critical Care Neonatal Nurse PractitionerTaxonomy code 363LN0005X

License

26NJ00655400 Issued in NJ

Practice address

94 Old Short Hills Rd
Livingston, NJ 07039-5672

Phone

(973) 322-5000

NPI assigned

Aug 29, 2016

Last updated

Aug 29, 2016By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1472428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472428800000",
    "number": "1467908517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 EDGEMERE RD",
            "city": "LIVINGSTON",
            "state": "NJ",
            "postal_code": "070392807",
            "telephone_number": "973-992-5247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "94 OLD SHORT HILLS RD",
            "city": "LIVINGSTON",
            "state": "NJ",
            "postal_code": "070395672",
            "telephone_number": "973-322-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHACKO",
        "first_name": "MINI",
        "credential": "NNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-08-29",
        "last_updated": "2016-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LN0005X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal, Critical Care",
            "state": "NJ",
            "license": "26NJ00655400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cerebral Palsy of North Jersey
• Cerebral Palsy of North Jersey
• Cerebral Palsy of North Jersey, Inc.
• Cerebral Palsy of North Jersey, Inc.
• Emmanuel Cha, D.D.S.
• Aaron Chalal, M.D.
• Arlina Mariano Chan, M.D.
• Kwanchai Chan, MD
• Natalie Chan, PA
• Wai Soon Chan, DO

• Critical Care Neonatal Nurse Practitioner in Livingston, NJ
• Providers in Livingston, NJ by specialty
• Critical Care Neonatal Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.