NPIMap

Organization Active NPI

Nitin Mariwalla MD PLLC

  • Neurological Surgery Physician
  • West Islip, NY
National Provider Identifier
1659943942
Registry record updated Oct 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
Legal business name
NITIN MARIWALLA MD PLLC
Practice address
1175 Montauk Hwy Ste 3
West Islip, NY 11795-4939
Phone
(631) 500-9400
Fax
(631) 500-9444
NPI assigned
Jul 15, 2021
Last updated
Oct 21, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Christian Galan
Title
Director of Client Services
Phone
(631) 500-9400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X NU Primary

Addresses

Primary practice location

1175 Montauk Hwy Ste 3
West Islip, NY 11795-4939

Mailing address

1175 Montauk Hwy Ste 3
West Islip, NY 11795-4939
Phone (631) 500-9400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220113001817 NY Part B Supplier - Clinic/Group Practice 0941692495 Receives reassigned benefits from 16 practitioners
Practice locations: Riverhead, NY; West Islip, NY; Smithtown, NY; Roslyn, NY; Rockville Centre, NY; Patchogue, NY; New York, NY; Jamaica, NY…

National Provider Directory

National Provider Directory

Locations

225 Community Dr
Ste 209
Great Neck, NY 11021

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761004800000",
    "number": "1659943942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1175 MONTAUK HWY STE 3",
            "city": "WEST ISLIP",
            "state": "NY",
            "postal_code": "117954939",
            "telephone_number": "631-500-9400",
            "fax_number": "631-500-9444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1175 MONTAUK HWY STE 3",
            "city": "WEST ISLIP",
            "state": "NY",
            "postal_code": "117954939",
            "telephone_number": "631-500-9400",
            "fax_number": "631-500-9444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NITIN MARIWALLA MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-15",
        "last_updated": "2025-10-21",
        "certification_date": "2025-10-21",
        "status": "A",
        "authorized_official_last_name": "GALAN",
        "authorized_official_first_name": "CHRISTIAN",
        "authorized_official_title_or_position": "DIRECTOR OF CLIENT SERVICES",
        "authorized_official_telephone_number": "631-500-9400"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Islip, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.