Healthcare Provider Details

I. General information

NPI: 1427159375
Provider Name (Legal Business Name): NAGINDER KAUR PURI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8268 164TH ST
JAMAICA NY
11432
US

IV. Provider business mailing address

7901 BROADWAY MANAGED CARE D101
ELMHURST NY
11373-1329
US

V. Phone/Fax

Practice location:
  • Phone: 718-883-3225
  • Fax: 718-883-6193
Mailing address:
  • Phone: 718-334-1921
  • Fax: 718-334-3432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number005178
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number005178
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: