Provider Demographics
NPI:1396001624
Name:CHERIAN, JINCY JACOB (DO)
Entity Type:Individual
Prefix:
First Name:JINCY
Middle Name:JACOB
Last Name:CHERIAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4626
Mailing Address - Country:US
Mailing Address - Phone:845-802-7600
Mailing Address - Fax:845-338-0307
Practice Address - Street 1:11 CRUM ELBOW RD
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-2852
Practice Address - Country:US
Practice Address - Phone:845-229-1020
Practice Address - Fax:845-229-2005
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY278124207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine