Healthcare Provider Details

I. General information

NPI: 1780647487
Provider Name (Legal Business Name): ELLEN C PUTTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PLAZA ST E APT A7
BROOKLYN NY
11238-4955
US

IV. Provider business mailing address

20 PLAZA ST E APT A7
BROOKLYN NY
11238-4955
US

V. Phone/Fax

Practice location:
  • Phone: 718-857-5500
  • Fax: 718-857-5533
Mailing address:
  • Phone: 718-857-5500
  • Fax: 718-857-5533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number192278
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: