Charles Peter Hackett I, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

163238 Issued in NY

Practice address

4427 Oak Beach Assn
47 Larboard CT.
Oak Beach, NY 11702-4619

Phone

(631) 422-1484

Fax

(631) 422-9103

NPI assigned

Oct 31, 2007

Last updated

Oct 31, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1193788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193788800000",
    "number": "1497934905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4427 OAK BEACH ASSN",
            "address_2": "47 LARBOARD CT.",
            "city": "OAK BEACH",
            "state": "NY",
            "postal_code": "117024619",
            "telephone_number": "631-422-1484",
            "fax_number": "631-422-9103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4427 OAK BEACH ASSN",
            "address_2": "47 LARBOARD CT.",
            "city": "OAK BEACH",
            "state": "NY",
            "postal_code": "117024619",
            "telephone_number": "631-422-1484",
            "fax_number": "631-422-9103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HACKETT",
        "first_name": "CHARLES",
        "middle_name": "PETER",
        "name_prefix": "Dr.",
        "name_suffix": "I",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-10-31",
        "last_updated": "2007-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "NY",
            "license": "163238",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "163238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2007; 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.