Healthcare Provider Details

I. General information

NPI: 1215211552
Provider Name (Legal Business Name): PUTNAM GI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2011
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

667 STONELEIGH AVE BUILDING A SUITE 201
CARMEL NY
10512-2454
US

IV. Provider business mailing address

667 STONELEIGH AVE STE 201
CARMEL NY
10512-2455
US

V. Phone/Fax

Practice location:
  • Phone: 845-278-5223
  • Fax: 845-278-4579
Mailing address:
  • Phone: 845-278-5223
  • Fax: 845-278-4579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number2059761
License Number StateNY

VIII. Authorized Official

Name: KERRY P COONEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 845-278-5223