Healthcare Provider Details

I. General information

NPI: 1598728396
Provider Name (Legal Business Name): DONALD C PUTMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 EAST NORTHFIELD ROAD SUITE 105
LIVINGSTON NJ
07039-4807
US

IV. Provider business mailing address

349 EAST NORTHFIELD ROAD SUITE 105
LIVINGSTON NJ
07039-4807
US

V. Phone/Fax

Practice location:
  • Phone: 973-597-3333
  • Fax: 973-597-3334
Mailing address:
  • Phone: 973-597-3333
  • Fax: 973-597-3334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number25MA06221900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number189637
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: