Individual
JERIN JOSE KORUTHU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
475 SEAVIEW AVE, STATEN ISLAND, NY 10305-3436
(718) 226-9000
Mailing address
475 SEAVIEW AVE, STATEN ISLAND, NY 10305-3436
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
11/02/2018
Last updated
11/02/2018
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