Provider Demographics
NPI:1972862803
Name:GANESHALINGAM, NIMALYA (MD)
Entity Type:Individual
Prefix:
First Name:NIMALYA
Middle Name:
Last Name:GANESHALINGAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 GREAT NECK RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3357
Mailing Address - Country:US
Mailing Address - Phone:516-487-4464
Mailing Address - Fax:516-487-4950
Practice Address - Street 1:170 GREAT NECK RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-3357
Practice Address - Country:US
Practice Address - Phone:516-487-4464
Practice Address - Fax:516-487-4950
Is Sole Proprietor?:No
Enumeration Date:2012-05-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA390200000X
390200000X
NY2845992084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program