Provider Demographics
NPI:1194047373
Name:JOSE, NALONNIL MATHAI (RPH)
Entity type:Individual
Prefix:
First Name:NALONNIL
Middle Name:MATHAI
Last Name:JOSE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 MONTEREY DR
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1031
Mailing Address - Country:US
Mailing Address - Phone:516-869-0678
Mailing Address - Fax:516-869-0678
Practice Address - Street 1:66 MONTEREY DR
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1031
Practice Address - Country:US
Practice Address - Phone:516-869-0678
Practice Address - Fax:516-869-0678
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040523-3183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY040523-3OtherNEW YORK STATE PHARMACIST LISCENSE #