Individual
MRS. JESSY TOM PATTANIYIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NPC
Contact information
Practice address
6501 HARBISON AVE, PHILADELPHIA, PA 19149-2912
(215) 333-4300
(215) 333-2044
Mailing address
6501 HARBISON AVE, PHILADELPHIA, PA 19149-2912
(215) 333-4300
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
SP010182
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1007278000
TPI MEDICAID GROUP ID
PA
01
—
597586
TPI MEDICARE GROUP
PA
01
—
CD4829
TPI RAILROAD MEDICARE GROUP
PA
Enumeration date
04/20/2009
Last updated
05/24/2022
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