Healthcare Provider Details

I. General information

NPI: 1982098539
Provider Name (Legal Business Name): RAJIV KUMAR PUNN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2015
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 MAIN ST STE 103
ARMONK NY
10504
US

IV. Provider business mailing address

322 UNDERHILL AVE
YORKTOWN HEIGHTS NY
10598-4547
US

V. Phone/Fax

Practice location:
  • Phone: 914-273-3404
  • Fax:
Mailing address:
  • Phone: 914-962-5501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number294622
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: