Healthcare Provider Details

I. General information

NPI: 1376770883
Provider Name (Legal Business Name): PUTNAM OBSTETRICS & GYNECOLOGY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2009
Last Update Date: 07/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 STONELEIGH AVE
CARMEL NY
10512-2466
US

IV. Provider business mailing address

660 STONELEIGH AVE
CARMEL NY
10512-2466
US

V. Phone/Fax

Practice location:
  • Phone: 845-279-2000
  • Fax: 845-279-3887
Mailing address:
  • Phone: 845-279-2000
  • Fax: 845-279-3887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number150208
License Number StateNY

VIII. Authorized Official

Name: JANUSZ EMIL RUDNICKI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 845-279-2000