Healthcare Provider Details

I. General information

NPI: 1851496749
Provider Name (Legal Business Name): NYMEDPUTNAM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 MOUNT EBO RD N
BREWSTER NY
10509-3600
US

IV. Provider business mailing address

46 MOUNT EBO RD N
BREWSTER NY
10509-3600
US

V. Phone/Fax

Practice location:
  • Phone: 845-278-3636
  • Fax: 845-278-5723
Mailing address:
  • Phone: 845-278-3636
  • Fax: 845-278-5723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number3950301N
License Number StateNY

VIII. Authorized Official

Name: MR. LAURENCE LADUE
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 845-278-3636