Healthcare Provider Details

I. General information

NPI: 1821066531
Provider Name (Legal Business Name): ANIBAL O PUENTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 12/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1578 WILLIAMSBRIDGE RD
BRONX NY
10461-6265
US

IV. Provider business mailing address

1578 WILLIAMSBRIDGE RD
BRONX NY
10461-6265
US

V. Phone/Fax

Practice location:
  • Phone: 718-904-1400
  • Fax: 718-824-3388
Mailing address:
  • Phone: 718-904-1400
  • Fax: 718-824-3388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number210144
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: