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Contact Information

KAVITA MARIWALLA, MD
1145 MONTAUK HWY
SUITE 1
WEST ISLIP, NY11795-4909
 Phone: 631-665-3376
 Fax: 631-969-3376
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

MOHS-Micrographic Surgery

207ND0101X 07 Physician/Dermatology
 

Dermatology

207N00000X 07 Physician/Dermatology
Indicates primary specialty

NPI Profile & details for KAVITA MARIWALLA · (Female)

NPI # 1962674184
Status Active
Credentials MD
Entity Individual
Enumeration date 03/27/2008
Last updated 09/28/2020 - About 6 years ago
Sole proprietor 1 Yes
Identifiers
  • CT License # 046352
  • NY License # 253189
Hospital affiliation(s)
  • GOOD SAMARITAN HOSPITAL MEDICAL CENTER - (Acute Care)
    1000 MONTAUK HIGHWAY
    WEST ISLIP, NY 11795
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.
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