Individual
JACOB THENGAMPALLIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
140 OLD ORANGEBURG RD, ORANGEBURG, NY 10962-1157
(845) 680-8694
Mailing address
140 OLD ORANGEBURG RD, ORANGEBURG, NY 10962-1157
(845) 680-8694
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
592600
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
403172
NY
Other
Enumeration date
05/01/2018
Last updated
11/03/2020
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