Provider Demographics
NPI:1750811352
Name:KOTHARY, NAOMI PRATIK (NP)
Entity type:Individual
Prefix:MS
First Name:NAOMI
Middle Name:PRATIK
Last Name:KOTHARY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NAOMI
Other - Middle Name:PRATIK
Other - Last Name:NARIELWALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:55 WATER ST FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10041-0010
Mailing Address - Country:US
Mailing Address - Phone:646-680-2888
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:1991 MARCUS AVE FL 2
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-2057
Practice Address - Country:US
Practice Address - Phone:516-354-1600
Practice Address - Fax:516-941-4673
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY702523163W00000X
NY431225363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY702523OtherNY STATE
NY431225OtherNURSE PRACTITIONER