Individual
MR. JITHU JOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
777 SEAVIEW AVE, STATEN ISLAND, NY 10305-3409
(347) 465-1556
Mailing address
777 SEAVIEW AVE, STATEN ISLAND, NY 10305-3409
(347) 465-1556
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
763060
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2997157
—
NY
Enumeration date
12/18/2019
Last updated
12/18/2019
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