Provider Demographics
NPI:1336577170
Name:KALLARACKAL, JOJIMOL MATHEW
Entity Type:Individual
Prefix:MRS
First Name:JOJIMOL
Middle Name:MATHEW
Last Name:KALLARACKAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 OAK RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-2535
Mailing Address - Country:US
Mailing Address - Phone:848-391-9940
Mailing Address - Fax:
Practice Address - Street 1:1818 OAK ROAD
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902
Practice Address - Country:US
Practice Address - Phone:732-422-0565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-14
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00453400363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics