Healthcare Provider Details

I. General information

NPI: 1134132095
Provider Name (Legal Business Name): MARC PUCHIR D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 05/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 E MONTAUK HWY STE 102
HAMPTON BAYS NY
11946-1878
US

IV. Provider business mailing address

185 OLD COUNTRY RD SUITE 2
RIVERHEAD NY
11901-2121
US

V. Phone/Fax

Practice location:
  • Phone: 631-728-4500
  • Fax: 631-594-3741
Mailing address:
  • Phone: 631-298-4479
  • Fax: 631-591-3047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number190941
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: