Provider Demographics
NPI:1093944183
Name:JOSEPH, KOCHURANI SHAJI (NP)
Entity Type:Individual
Prefix:MRS
First Name:KOCHURANI
Middle Name:SHAJI
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 JEANNES PL
Mailing Address - Street 2:
Mailing Address - City:TAPPAN
Mailing Address - State:NY
Mailing Address - Zip Code:10983-2215
Mailing Address - Country:US
Mailing Address - Phone:845-613-7533
Mailing Address - Fax:
Practice Address - Street 1:1 JEANNES PL
Practice Address - Street 2:
Practice Address - City:TAPPAN
Practice Address - State:NY
Practice Address - Zip Code:10983-2215
Practice Address - Country:US
Practice Address - Phone:845-613-7533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF305158-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health