Provider Demographics
NPI:1669750907
Name:PILLALAMARRI, NIRMALA (MD)
Entity type:Individual
Prefix:DR
First Name:NIRMALA
Middle Name:
Last Name:PILLALAMARRI
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 1:865 NORTHERN BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5335
Mailing Address - Country:US
Mailing Address - Phone:516-622-5114
Mailing Address - Fax:
Practice Address - Street 1:865 NORTHERN BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5335
Practice Address - Country:US
Practice Address - Phone:516-622-5114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY263882207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery