Healthcare Provider Details

I. General information

NPI: 1427888544
Provider Name (Legal Business Name): KAMILA NURITOVA MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 05/10/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 CONEY ISLAND AVE
BROOKLYN NY
11223-2329
US

IV. Provider business mailing address

184 CARLTON AVE APT 1
BROOKLYN NY
11205-3210
US

V. Phone/Fax

Practice location:
  • Phone: 212-582-9100
  • Fax:
Mailing address:
  • Phone: 917-902-7165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number407247
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number91186601
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: