Provider Demographics
NPI:1326046715
Name:ILAMATHI, EKAMBARAM (MD)
Entity Type:Individual
Prefix:DR
First Name:EKAMBARAM
Middle Name:
Last Name:ILAMATHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 S WINDSOR AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGHTWATERS
Mailing Address - State:NY
Mailing Address - Zip Code:11718-1505
Mailing Address - Country:US
Mailing Address - Phone:516-318-8527
Mailing Address - Fax:
Practice Address - Street 1:38 S WINDSOR AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTWATERS
Practice Address - State:NY
Practice Address - Zip Code:11718-1505
Practice Address - Country:US
Practice Address - Phone:516-318-8527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY126913207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00384827Medicaid
NY390001418OtherMEDICARE RAILROAD
NY337741OtherEMPIRE BLUECROSS BLUSHIEL
NYCS665OtherOXFORD
NY1318OtherVYTRA
NY390001418OtherMEDICARE RAILROAD
NY337741Medicare ID - Type Unspecified