Provider Demographics
NPI:1699734970
Name:NANJAPPA, NIRMALA (MD)
Entity type:Individual
Prefix:
First Name:NIRMALA
Middle Name:
Last Name:NANJAPPA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NIRMALA
Other - Middle Name:
Other - Last Name:NANJAPPA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:10 LETY LN
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:NY
Mailing Address - Zip Code:10901-3961
Mailing Address - Country:US
Mailing Address - Phone:845-323-0761
Mailing Address - Fax:
Practice Address - Street 1:40 PARK AVE
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-5504
Practice Address - Country:US
Practice Address - Phone:845-369-0077
Practice Address - Fax:845-368-0022
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216636207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02234600Medicaid
NY02234600Medicaid