Healthcare Provider Details

I. General information

NPI: 1750811352
Provider Name (Legal Business Name): NAOMI PRATIK KOTHARY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NAOMI PRATIK NARIELWALA

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1991 MARCUS AVE FL 2
NEW HYDE PARK NY
11042-2057
US

IV. Provider business mailing address

55 WATER ST FL 2
NEW YORK NY
10041-0010
US

V. Phone/Fax

Practice location:
  • Phone: 516-354-1600
  • Fax: 516-941-4673
Mailing address:
  • Phone: 646-680-2888
  • Fax: 516-542-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number702523
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number431225
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: