Healthcare Provider Details

I. General information

NPI: 1245083252
Provider Name (Legal Business Name): POORNIMA JAISWAL CHARPURIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2024
Last Update Date: 12/19/2024
Certification Date:
Deactivation Date: 11/20/2024
Reactivation Date: 12/19/2024

III. Provider practice location address

1901 FIRST AVENUE AT 97TH STREET NYC H&H/METROPOLITAN HOSPITAL, DEPARTMENT OF MEDICINE
NEW YORK CITY NY
10029
US

IV. Provider business mailing address

1955 FIRST AVENUE APARTMENT 439
NEW YORK CITY NY
10029
US

V. Phone/Fax

Practice location:
  • Phone: 212-423-6771
  • Fax: 212-423-8099
Mailing address:
  • Phone: 917-302-5516
  • Fax: 212-423-8099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: