Provider Demographics
NPI:1578967204
Name:KALLACHERIL, JOBIN GEORGE (APN)
Entity Type:Individual
Prefix:
First Name:JOBIN
Middle Name:GEORGE
Last Name:KALLACHERIL
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-1201
Mailing Address - Country:US
Mailing Address - Phone:908-328-8013
Mailing Address - Fax:
Practice Address - Street 1:149 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-1201
Practice Address - Country:US
Practice Address - Phone:908-328-8013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00500000363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health