Provider Demographics
NPI:1033378161
Name:MARIWALLA, NITIN RAJKUMAR (MD, MPH, MS)
Entity Type:Individual
Prefix:DR
First Name:NITIN
Middle Name:RAJKUMAR
Last Name:MARIWALLA
Suffix:
Gender:M
Credentials:MD, MPH, MS
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Mailing Address - Street 1:1175 MONTAUK HWY
Mailing Address - Street 2:STE 3
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4939
Mailing Address - Country:US
Mailing Address - Phone:631-500-9400
Mailing Address - Fax:631-500-9444
Practice Address - Street 1:1175 MONTAUK HWY
Practice Address - Street 2:STE 3
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795
Practice Address - Country:US
Practice Address - Phone:631-500-9400
Practice Address - Fax:631-500-9444
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY287808207T00000X
390200000X390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program