Healthcare Provider Details

I. General information

NPI: 1275584831
Provider Name (Legal Business Name): PUTNAM FAMILY MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 ROUTE 6 BREWSTER CARMEL PROF BLDG
BREWSTER NY
10509-2527
US

IV. Provider business mailing address

2424 ROUTE 6 BREWSTER CARMEL PROF BLDG
BREWSTER NY
10509-2527
US

V. Phone/Fax

Practice location:
  • Phone: 845-278-2720
  • Fax:
Mailing address:
  • Phone: 845-278-2720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number186733
License Number StateNY

VIII. Authorized Official

Name: DR. MICHAEL J NESHEIWAT
Title or Position: DIRECTOR OFFICER
Credential: M.D.
Phone: 845-278-2720