Provider Demographics
NPI:1720621345
Name:KOSHY, JOOLY P (APN)
Entity Type:Individual
Prefix:DR
First Name:JOOLY
Middle Name:P
Last Name:KOSHY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MRS
Other - First Name:JOOLY
Other - Middle Name:P
Other - Last Name:MATHEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:JOOLY P MATHEW
Mailing Address - Street 1:11 TAURUS CT
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1711
Mailing Address - Country:US
Mailing Address - Phone:732-644-4858
Mailing Address - Fax:
Practice Address - Street 1:150 BERGEN STREET
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103
Practice Address - Country:US
Practice Address - Phone:972-972-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-26
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01002000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily