Provider Demographics
NPI:1376851956
Name:JOSE, JYOTHI (NP)
Entity Type:Individual
Prefix:MRS
First Name:JYOTHI
Middle Name:
Last Name:JOSE
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 1:20 BRYANT AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2802
Mailing Address - Country:US
Mailing Address - Phone:516-305-5123
Mailing Address - Fax:
Practice Address - Street 1:260-05, 76TH AVENUE
Practice Address - Street 2:NORTH SHORE LONG ISLAND JEWISH HEALTH SYSTEM
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040
Practice Address - Country:US
Practice Address - Phone:718-470-7870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336456363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily