Provider Demographics
NPI:1528812955
Name:CHACKO, MERLIN (NP)
Entity type:Individual
Prefix:MS
First Name:MERLIN
Middle Name:
Last Name:CHACKO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:MERLIN
Other - Middle Name:
Other - Last Name:SIMON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1 GUSTAVE L LEVY PL FL 12
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6574
Mailing Address - Country:US
Mailing Address - Phone:718-926-8200
Mailing Address - Fax:
Practice Address - Street 1:1 GUSTAVE L LEVY PL FL 12
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6574
Practice Address - Country:US
Practice Address - Phone:212-241-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF311226-01363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health