Healthcare Provider Details

I. General information

NPI: 1073140539
Provider Name (Legal Business Name): DANIELLE ELIZABETH PUTUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 08/04/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 NORTHERN BOULEVARD SUITE 200
BRONX NY
10467-2401
US

IV. Provider business mailing address

611 NORTHERN BLOUEVARD SUITE 200
GREAT NECK NY
11021
US

V. Phone/Fax

Practice location:
  • Phone: 855-201-3272
  • Fax: 516-325-7190
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number336268-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: