Healthcare Provider Details

I. General information

NPI: 1669423216
Provider Name (Legal Business Name): YEDAHALLI VANITHA PUTTASWAMY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 N VAN DIEN AVE
RIDGEWOOD NJ
07450-2726
US

IV. Provider business mailing address

9 SPLIT ROCK RD
CHESTER NY
10918-1709
US

V. Phone/Fax

Practice location:
  • Phone: 845-469-9489
  • Fax: 201-447-8491
Mailing address:
  • Phone: 845-469-9489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number25MA04943900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: