Basic Information
| Provider Information | |||||||||
| NPI: | 1639401797 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ARIKUPURATHU | ||||||||
| FirstName: | NISHA | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | C.N.M | ||||||||
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| Mailing Information | |||||||||
| Address1: | 74 LAUREL DR | ||||||||
| Address2: | |||||||||
| City: | NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110402046 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 8906 135TH ST | ||||||||
| Address2: | SUITE 6A | ||||||||
| City: | JAMAICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114182821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182066808 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2010 | ||||||||
| LastUpdateDate: | 02/04/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 176B00000X | F001343 | NY | Y | Other Service Providers | Midwife |
ID Information
| ID | Type | State | Issuer | Description | 03484791 | 05 | NY | MEDICAID |