Provider Demographics
NPI:1609859453
Name:PILLAI, NISHA U (MD)
Entity Type:Individual
Prefix:MRS
First Name:NISHA
Middle Name:U
Last Name:PILLAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:NISHA
Other - Middle Name:
Other - Last Name:RAJAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 MALTESE DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2115
Mailing Address - Country:US
Mailing Address - Phone:845-342-4774
Mailing Address - Fax:845-343-8741
Practice Address - Street 1:111 MALTESE DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2115
Practice Address - Country:US
Practice Address - Phone:845-342-4774
Practice Address - Fax:845-343-8741
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-25
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222069207RC0000X
NY222069-1207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02680317Medicaid
NY02680317Medicaid
NY658Q41Medicare PIN
NYI42510Medicare UPIN