Healthcare Provider Details

I. General information

NPI: 1871761833
Provider Name (Legal Business Name): JAYA J KUSUMALAYAM RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 INDIAN ROCK
SUFFERN NY
10901-4907
US

IV. Provider business mailing address

11 ADAMS LN
AIRMONT NY
10901-7114
US

V. Phone/Fax

Practice location:
  • Phone: 845-357-1500
  • Fax: 845-369-7759
Mailing address:
  • Phone: 845-357-1500
  • Fax: 845-369-7759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number045106-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: