Provider Demographics
NPI:1487613493
Name:ASIRWATHAM, KAMALINI (MD)
Entity type:Individual
Prefix:DR
First Name:KAMALINI
Middle Name:
Last Name:ASIRWATHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAMALINI
Other - Middle Name:
Other - Last Name:NALLATHAMBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:34 ACADEMY PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-1854
Mailing Address - Country:US
Mailing Address - Phone:718-727-9670
Mailing Address - Fax:718-448-5396
Practice Address - Street 1:34 ACADEMY PL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-1854
Practice Address - Country:US
Practice Address - Phone:718-727-9670
Practice Address - Fax:718-448-5396
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2318512084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Not Answered2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02730312Medicaid
NY02730312Medicaid
NY642N51Medicare ID - Type Unspecified