Basic Information
| Provider Information | |||||||||
| NPI: | 1033267174 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHACHERE | ||||||||
| FirstName: | JULIA | ||||||||
| MiddleName: | REBEKAH THEODORA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP, CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | PECONIC BAY PRIMARY CARE | ||||||||
| Address2: | P.O. BOX 2377 | ||||||||
| City: | RIVERHEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312984479 | ||||||||
| FaxNumber: | 6312590298 | ||||||||
| Practice Location | |||||||||
| Address1: | NORTH FORK FAMILY PRACTICE | ||||||||
| Address2: | 32845 MAIN ROAD | ||||||||
| City: | CUTCHOGUE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314053235 | ||||||||
| FaxNumber: | 6312590298 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2007 | ||||||||
| LastUpdateDate: | 08/21/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 176B00000X | F001238-1 | NY | N | Other Service Providers | Midwife | 176B00000X | F001238 | NY | N | Other Service Providers | Midwife | 363LW0102X | F420821 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | 02912783 | 05 | NY | MEDICAID |