Provider Demographics
NPI:1235806191
Name:SAMUEL, NIRMALA
Entity Type:Individual
Prefix:MRS
First Name:NIRMALA
Middle Name:
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HEGEMAN AVE APT 7D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-4753
Mailing Address - Country:US
Mailing Address - Phone:917-993-0991
Mailing Address - Fax:
Practice Address - Street 1:7 HEGEMAN AVE APT 7D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-4753
Practice Address - Country:US
Practice Address - Phone:917-993-0991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF348218363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF348218OtherTHE UNIVERSITY OF THE STATE OF NEW YORK