Healthcare Provider Details

I. General information

NPI: 1386185221
Provider Name (Legal Business Name): MARTINA LOUISE PUCHTA MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2017
Last Update Date: 03/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 W 166TH ST 4TH FLOOR
NEW YORK NY
10032-4207
US

IV. Provider business mailing address

513 W 166TH ST 4TH FLOOR
NEW YORK NY
10032-4207
US

V. Phone/Fax

Practice location:
  • Phone: 212-928-8300
  • Fax: 212-928-8392
Mailing address:
  • Phone: 212-928-8300
  • Fax: 212-928-8392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number627312
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF341153
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: