Provider Demographics
NPI:1982037057
Name:GEORGE, LIJO I (RN)
Entity Type:Individual
Prefix:MR
First Name:LIJO
Middle Name:I
Last Name:GEORGE
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 1:122 SMITH HILL RD
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-7735
Mailing Address - Country:US
Mailing Address - Phone:845-300-7320
Mailing Address - Fax:
Practice Address - Street 1:122 SMITH HILL RD
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-7735
Practice Address - Country:US
Practice Address - Phone:845-300-7320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY674951163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse