Healthcare Provider Details

I. General information

NPI: 1508131418
Provider Name (Legal Business Name): PUTNAM PEDIATRIC MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2012
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

667 STONELEIGH AVENUE SUITE 111
CARMEL NY
10512
US

IV. Provider business mailing address

667 STONELEIGH AVENUE SUITE 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 Number
License Number State

VIII. Authorized Official

Name: DR. ALFREDO GARCIA
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 845-279-5131