Organization
ILLUMINATE NP PSYCHIATRY
Active
Other names
Illuminate NP Psychiatry, PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
AMY KOTARSKI (OWNER)
(716) 903-6036
Entity
Organization
Contact information
Practice address
3595 EGGERT RD, ORCHARD PARK, NY 14127-1929
(716) 903-6036
(716) 463-2225
Mailing address
3595 EGGERT RD, ORCHARD PARK, NY 14127-1929
(716) 903-6036
(716) 463-2225
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05703237
—
NY
Enumeration date
01/27/2021
Last updated
09/08/2025
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