Most Relevant Information
Provider Data
| NPI Number: | 1003254657 |
| Provider Name: | JAISA JOSEPH PALLICKAL MSN ANP |
| Entity Type: | Individual |
| Taxonomy Code: | 364SA2200X |
| Specialty: | Clinical Nurse Specialist |
| License Number: | 305563 |
Most Important Dates
| Enumeration Date: | 06/05/2013 |
| Last Updated: | 06/05/2013 |
Provider Practice Location
75 BROAD ST
0815
NEW YORK
NY
100042415
Practice Location Phone/Fax
| Phone: | 7183910611 |
| Fax: |
Provider Mailing Location
17 BEST ST
WESTWOOD
NJ
076752701
Provider Mailing Phone/Fax
| Phone: | 2013580349 |
| Fax: |