Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | F40134 | NY |
NPI | 1023313459 |
---|---|
Provider Name | Mr. Jacob Palathinkal |
First Address | Glen Oaks, NY 11004-1150 |
Second Address | Glen Oaks, NY 11004-1150 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2011 |
Last Update Date | 31/12/2013 |