Individual
DR. MANJUMMELKUDIYIL P KURUVILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9 4TH AVE, BAY SHORE, NY 11706-7908
(631) 968-9102
Mailing address
15 CEDAR RIDGE LN, DIX HILLS, NY 11746-7936
(631) 968-9102
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
128155-1
NY
Other
Enumeration date
03/07/2007
Last updated
10/05/2012
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