Individual
LISSY MATHEW KOCHUPURACKAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7403 COMMONWEALTH BLVD, BELLEROSE, NY 11426-1839
(917) 601-3543
Mailing address
8141 249TH ST, BELLEROSE, NY 11426-2517
(917) 601-3543
Taxonomy
Speciality
Code
Description
License number
State
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
Primary
0714671
NY
Other
Enumeration date
10/31/2019
Last updated
05/14/2024
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