Provider Demographics
NPI:1578384988
Name:PHILIPOSE, MABLE
Entity type:Individual
Prefix:
First Name:MABLE
Middle Name:
Last Name:PHILIPOSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 KENSINGTON CT
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-2108
Mailing Address - Country:US
Mailing Address - Phone:516-675-8685
Mailing Address - Fax:
Practice Address - Street 1:56 KENSINGTON CT
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-2108
Practice Address - Country:US
Practice Address - Phone:516-675-8685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY952839163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse