Provider Demographics
NPI:1447323381
Name:MANCHERY, JESSYMOL V (NP-FAMILY)
Entity type:Individual
Prefix:MRS
First Name:JESSYMOL
Middle Name:V
Last Name:MANCHERY
Suffix:
Gender:F
Credentials:NP-FAMILY
Other - Prefix:MRS
Other - First Name:JESSYMOL
Other - Middle Name:V
Other - Last Name:MANCHERY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:577 LUDLOW AVE
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-3231
Mailing Address - Country:US
Mailing Address - Phone:908-276-5745
Mailing Address - Fax:
Practice Address - Street 1:355 GRAND ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-4321
Practice Address - Country:US
Practice Address - Phone:201-915-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00099300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMM1389027OtherDEA
NJMM1389027OtherDEA