Healthcare Provider Details

I. General information

NPI: 1417793209
Provider Name (Legal Business Name): PRIYA JOSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 OLD ORANGEBURG RD
ORANGEBURG NY
10962-1157
US

IV. Provider business mailing address

240 RIDGE RD
NEW CITY NY
10956-6911
US

V. Phone/Fax

Practice location:
  • Phone: 845-680-8600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number830317
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: