Healthcare Provider Details

I. General information

NPI: 1497799399
Provider Name (Legal Business Name): BIJU K JOSE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 01/06/2024
Certification Date: 01/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 POST AVE
WESTBURY NY
11590-3060
US

IV. Provider business mailing address

PO BOX 13700 1378 BROOKHAVEN MEMORIAL HOSPITAL ER
PHILADELPHIA PA
19191-1378
US

V. Phone/Fax

Practice location:
  • Phone: 631-654-7236
  • Fax: 610-617-6280
Mailing address:
  • Phone: 800-666-2455
  • Fax: 610-617-6280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number06795
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF310277
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: