Healthcare Provider Details

I. General information

NPI: 1457521064
Provider Name (Legal Business Name): JESSY P JOSE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE GUSTAVE L LEVY PLACE THE MOUNT SINAI MEDICAL CENTER
NEWYORK NY
10029
US

IV. Provider business mailing address

ONE GUSTAVE L LEVY PLACE THE MOUNT SINAI MEDICAL CENTER
NEWYORK NY
10029
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-8095
  • Fax:
Mailing address:
  • Phone: 212-241-8095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number333251
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: