Individual
DR. JISHA EDICHANDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
7632 264TH ST, FLORAL PARK, NY 11004-1145
(917) 647-7822
Mailing address
7632 264TH ST, FLORAL PARK, NY 11004-1145
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
48653
CT
Other
Enumeration date
01/19/2011
Last updated
01/19/2011
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