Healthcare Provider Details

I. General information

NPI: 1134388135
Provider Name (Legal Business Name): VINAY GANESH PUTTANNIAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST M-312
NEW YORK NY
10065-4870
US

IV. Provider business mailing address

525 E 68TH ST M-312
NEW YORK NY
10065-4870
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-2941
  • Fax:
Mailing address:
  • Phone: 212-746-2941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number241789
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: