Provider Demographics
NPI:1871817445
Name:NATH, INDRANI
Entity Type:Individual
Prefix:
First Name:INDRANI
Middle Name:
Last Name:NATH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:INDRANI
Other - Middle Name:
Other - Last Name:NATH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:11 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-3606
Mailing Address - Country:US
Mailing Address - Phone:516-759-6217
Mailing Address - Fax:
Practice Address - Street 1:11 GROVE ST
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-3606
Practice Address - Country:US
Practice Address - Phone:516-759-6217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY586545163W00000X, 163WA2000X, 261QM0855X, 273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No273R00000XHospital UnitsPsychiatric Unit