Jaisa Joseph Pallickal, MSN ANP

Primary specialty

Adult Health Clinical Nurse SpecialistTaxonomy code 364SA2200X

License

305563 Issued in NY

Practice address

75 Broad St
0815
New York, NY 10004-2415

Phone

(718) 391-0611

NPI assigned

Jun 5, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Annamma Zachariah Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science - Nursing

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1370390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370390400000",
    "number": "1003254657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 BEST ST",
            "city": "WESTWOOD",
            "state": "NJ",
            "postal_code": "076752701",
            "telephone_number": "201-358-0349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 BROAD ST",
            "address_2": "0815",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100042415",
            "telephone_number": "718-391-0611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PALLICKAL",
        "first_name": "JAISA",
        "middle_name": "JOSEPH",
        "name_prefix": "Mrs.",
        "credential": "MSN ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-05",
        "last_updated": "2013-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SA2200X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Adult Health",
            "state": "NY",
            "license": "305563",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANNAMMA",
            "last_name": "ZACHARIAH",
            "prefix": "MRS.",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Trinity Pallaria
• Nicole Mariel Pallas, DDS
• Krishnakumari G Pallegar, MD
• Kristen Mary Palleo, FNP-BC
• Sarah Paller
• John Pallis, PHARMD
• Nicholas Pallis, PA
• Theresa Elizabeth Pallotta, MD
• Palm Behavioral Health Services, P.a.
• Phyllis W Palm, PHD

• Adult Health Clinical Nurse Specialist in New York, NY
• Providers in New York, NY by specialty
• Adult Health Clinical Nurse Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.