Healthcare Provider Details

I. General information

NPI: 1033321997
Provider Name (Legal Business Name): NIRMALA KOTHA RN, MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 BROADWAY CHONY 3 TOWER, RM # 331
NEW YORK NY
10032-1559
US

IV. Provider business mailing address

3959 BROADWAY CHONY 3 TOWER, RM # 331
NEW YORK NY
10032-1559
US

V. Phone/Fax

Practice location:
  • Phone: 212-342-8687
  • Fax: 212-342-8676
Mailing address:
  • Phone: 212-342-8687
  • Fax: 212-342-8676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF333185
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: