Healthcare Provider Details

I. General information

NPI: 1861254039
Provider Name (Legal Business Name): JOSE CIJIN PUTHUSSERY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOSE CIJIN PUTHUSSERY MD

II. Dates (important events)

Enumeration Date: 01/24/2024
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 PENN AVE
PITTSBURGH PA
15224-1334
US

IV. Provider business mailing address

4401 PENN AVE
PITTSBURGH PA
15224-1334
US

V. Phone/Fax

Practice location:
  • Phone: 216-622-5871
  • Fax:
Mailing address:
  • Phone: 216-622-5871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD491294
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35.151513
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number5761578
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: