Individual
JAIMIE VETTICHIRA SAMUEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O
Contact information
Practice address
25 SMITH ST FL 2, NANUET, NY 10954-2912
(845) 623-7100
Mailing address
22 POPLAR ST, ELMSFORD, NY 10523-3726
(914) 409-3103
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
0102205729
VA
208000000X
Pediatrics Physician
Primary
280311
NY
Other
Enumeration date
09/10/2014
Last updated
08/29/2022
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