Individual
DIVYA RATHISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
833 NORTHERN BLVD STE 220, GREAT NECK, NY 11021-5339
(516) 622-7986
Mailing address
26 MCKEE ST, FLORAL PARK, NY 11001-1616
(516) 474-6620
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
F351192
NY
Other
Enumeration date
06/14/2023
Last updated
06/14/2023
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