Healthcare Provider Details

I. General information

NPI: 1487862801
Provider Name (Legal Business Name): PURANIK FAMILY MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

546 S BROAD ST UNIT 2E
MERIDEN CT
06450-6600
US

IV. Provider business mailing address

546 S BROAD ST STE 2E UNIT 2E
MERIDEN CT
06450-6601
US

V. Phone/Fax

Practice location:
  • Phone: 203-237-1054
  • Fax: 203-237-9913
Mailing address:
  • Phone: 203-237-1054
  • Fax: 203-237-9913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. UJWALA P PURANIK
Title or Position: MEMBERLLC
Credential: M.D
Phone: 203-237-1054