Provider Demographics
NPI:1861254039
Name:JOSE, CIJIN P (MD)
Entity type:Individual
Prefix:DR
First Name:CIJIN
Middle Name:P
Last Name:JOSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSE CIJIN
Other - Middle Name:
Other - Last Name:PUTHUSSERY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1750 W 28TH ST APT 104
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-3074
Mailing Address - Country:US
Mailing Address - Phone:216-622-5871
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-622-5871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-24
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.255887207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology