MEDICARE: NYMEDPUTNAM, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	3950301N	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851496749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NYMEDPUTNAM, INC.

Provider Business Mailing Address
First Line	:	46 MOUNT EBO RD N
Second Line	:
City	:	BREWSTER
State	:	NY
Zip	:	10509-3600
Country	:	US
Telephone Number	:	845-278-3636
Fax Number	:	845-278-5723

Provider Business Practice Location Address
First Line	:	46 MOUNT EBO RD N
Second Line	:
City	:	BREWSTER
State	:	NY
Zip	:	10509-3600
Country	:	US
Telephone Number	:	845-278-3636
Fax Number	:	845-278-5723

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. LAURENCE LADUE
Credential	:	LNHA
Telephone Number	:	845-278-3636

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	03/28/2008

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