Provider Demographics
NPI:1639401797
Name:ARIKUPURATHU, NISHA E (CNM)
Entity Type:Individual
Prefix:MS
First Name:NISHA
Middle Name:E
Last Name:ARIKUPURATHU
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2046
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8906 135TH ST
Practice Address - Street 2:SUITE 6A
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11418-2821
Practice Address - Country:US
Practice Address - Phone:718-206-6808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-01
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF001343176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03484791Medicaid