Individual
JOLLY THANKACHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
525 E 68TH ST, NEW YORK, NY 10065-4870
(212) 746-2962
Mailing address
575 LEXINGTON AVE, NEW YORK, NY 10022-6102
(212) 746-2962
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
588457
NY
163W00000X
Registered Nurse
9433625
FL
367500000X
Certified Registered Nurse Anesthetist
Primary
588457
NY
Other
Enumeration date
08/06/2019
Last updated
03/12/2020
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