Individual
MARIAMMA C OOMMEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
79 25 WINCHESTER BLVD, QUEENS VILLAGE, NY 11427
(718) 264-4420
Mailing address
7925 WINCHESTER BLVD, QUEENS VILLAGE, NY 11427-2128
(718) 264-4420
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
429210
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
50150
—
NY
Enumeration date
02/06/2018
Last updated
02/06/2018
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