Provider Demographics
NPI:1437332830
Name:KURUVILLA, OMANA (FAMILY NURSE PRACTIT)
Entity Type:Individual
Prefix:MRS
First Name:OMANA
Middle Name:
Last Name:KURUVILLA
Suffix:
Gender:F
Credentials:FAMILY NURSE PRACTIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 GRAVES STREET
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314
Mailing Address - Country:US
Mailing Address - Phone:718-982-0232
Mailing Address - Fax:
Practice Address - Street 1:2195 E 22ND ST
Practice Address - Street 2:#1C HEALTHWAY MEDICAL PC IRINA LELCHUK MD DO
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3602
Practice Address - Country:US
Practice Address - Phone:718-648-4545
Practice Address - Fax:718-648-7788
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-10
Last Update Date:2008-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ12207Medicare UPIN
NY0194GCW781Medicare PIN