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General NPI Number Information
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NPI Number | 1720621345
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Entity Type | Individual
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Provider Name | JOOLY P KOSHY APN
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Gender | Female
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Dates
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Enumeration Date | 10/26/2019
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Last Update Date | 12/27/2019
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Provider Practice Location Address
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Address Line | 150 BERGEN STREET
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City | NEWARK
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State | NJ
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Zip | 07103
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Country | US
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Telephone | 972-972-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 11 TAURUS CT
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City | EDISON
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State | NJ
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Zip | 08820-1711
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Country | US
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Telephone | 732-644-4858
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ01002000
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License Number State | NJ
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