Provider Demographics
NPI:1689102998
Name:CHIRACKAL, ROBIN S (MD)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:S
Last Name:CHIRACKAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHIRACKAL
Other - Middle Name:
Other - Last Name:ROBIN SUNNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:565 NEW BRUNSWICK AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FORDS
Mailing Address - State:NJ
Mailing Address - Zip Code:08863-2162
Mailing Address - Country:US
Mailing Address - Phone:212-994-5100
Mailing Address - Fax:
Practice Address - Street 1:330 W 58TH ST STE 509
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1819
Practice Address - Country:US
Practice Address - Phone:212-994-5100
Practice Address - Fax:212-994-5101
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10061266207Q00000X
NY318362207QG0300X, 207QS1201X
NE8218207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine