MEDICARE: THOMAS VIJI PULICKAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1275477077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS VIJI PULICKAL

Provider Business Mailing Address
First Line	:	25 POCONO ROAD, SAINT CLARE'S HEALTH
Second Line	:	GME OFFICE-2ND FLOOR, C-WING
City	:	DENVILLE
State	:	NJ
Zip	:	07834
Country	:	US
Telephone Number	:	973-365-4661
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 POCONO ROAD, SAINT CLARE'S HEALTH
Second Line	:	GME OFFICE-2ND FLOOR, C-WING
City	:	DENVILLE
State	:	NJ
Zip	:	07834
Country	:	US
Telephone Number	:	973-365-4661
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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