Healthcare Provider Details

I. General information

NPI: 1346726296
Provider Name (Legal Business Name): MRS. LISHA JOBIN KALLACHERIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 WESCOTT DR
FLEMINGTON NJ
08822-4603
US

IV. Provider business mailing address

215 STATE ROUTE 31 RM 116
FLEMINGTON NJ
08822-5752
US

V. Phone/Fax

Practice location:
  • Phone: 908-788-6100
  • Fax:
Mailing address:
  • Phone: 908-284-1125
  • Fax: 908-284-2016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR11517200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number26NJ00796900
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number26NJ00796900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: