Provider Demographics
NPI:1790297893
Name:MANALILJOY, JINU (RN)
Entity Type:Individual
Prefix:
First Name:JINU
Middle Name:
Last Name:MANALILJOY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 RITCHIE DR
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-4517
Mailing Address - Country:US
Mailing Address - Phone:347-575-5426
Mailing Address - Fax:
Practice Address - Street 1:2527 GLEBE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3109
Practice Address - Country:US
Practice Address - Phone:718-904-7172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-30
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY671701163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse