Healthcare Provider Details

I. General information

NPI: 1043261266
Provider Name (Legal Business Name): MARTHA PIMENTEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 05/24/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PUTNAM PEDIATRICS 667 STONELEIGH AVENUE, SUIT 111
CARMEL NY
10512
US

IV. Provider business mailing address

PUTNAM PEDIATRICS 667 STONELEIGH AVENUE, SUIT 111
CARMEL NY
10512
US

V. Phone/Fax

Practice location:
  • Phone: 845-279-9652
  • Fax: 845-279-3606
Mailing address:
  • Phone: 845-279-9652
  • Fax: 845-279-3606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number236366
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: