Individual
MANJU KOYAKKATTU THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
111 E 210TH ST, BRONX, NY 10467-2401
(718) 920-4000
Mailing address
1 SADDLE LN, NEW CITY, NY 10956-6013
(845) 653-6533
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
345568-01
NY
Other
Enumeration date
06/26/2020
Last updated
06/26/2020
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