Active NPI
Davis Chacko
- Student in an Organized Health Care Education/Training Program
- Newark, NJ
National Provider Identifier
1861079162
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 150 Bergen St
Newark, NJ 07103-2496 - Phone
- (973) 972-4300
- NPI assigned
- Mar 24, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
150 Bergen St
Newark, NJ 07103-2496
Mailing address
12525 Kenny Dr
Granada Hills, CA 91344-1838
Phone (818) 987-1033
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | http://njms.rutgers.edu/departments/pathology/index.cfm |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1616544000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1616544000000",
"number": "1861079162",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12525 KENNY DR",
"city": "GRANADA HILLS",
"state": "CA",
"postal_code": "913441838",
"telephone_number": "818-987-1033"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "150 BERGEN ST",
"city": "NEWARK",
"state": "NJ",
"postal_code": "071032496",
"telephone_number": "973-972-4300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHACKO",
"first_name": "DAVIS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-03-24",
"last_updated": "2021-03-24",
"certification_date": "2021-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "http://njms.rutgers.edu/departments/pathology/index.cfm",
"affiliation": "N",
"address_1": "150 Bergen St",
"city": "Newark",
"state": "NJ",
"country_code": "US",
"postal_code": "071032496",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Newark, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.