Individual
MARYKUTTY JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP-C
Contact information
Practice address
450 LAKEVILLE RD, SUITE M41, NEW HYDE PARK, NY 11042-1117
(516) 734-8500
(516) 734-8537
Mailing address
450 LAKEVILLE RD, SUITE M41, NEW HYDE PARK, NY 11042-1117
(516) 734-8500
(516) 734-8537
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F 3055327-1
NY
Other
Enumeration date
12/16/2010
Last updated
12/16/2010
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