Provider Demographics
NPI:1891579850
Name:PITIGALA, NILUCKSHI
Entity Type:Individual
Prefix:
First Name:NILUCKSHI
Middle Name:
Last Name:PITIGALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 E 71ST ST OFC 5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4839
Mailing Address - Country:US
Mailing Address - Phone:212-991-8599
Mailing Address - Fax:
Practice Address - Street 1:525 E 71ST ST OFC 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4839
Practice Address - Country:US
Practice Address - Phone:212-774-2138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF351441-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily