Healthcare Provider Details

I. General information

NPI: 1043521040
Provider Name (Legal Business Name): MELISSA ERIN PUTTERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 E 84TH ST ROOM 205
NEW YORK NY
10028-2972
US

IV. Provider business mailing address

245 E 63RD ST APT 32C
NEW YORK NY
10065-7466
US

V. Phone/Fax

Practice location:
  • Phone: 212-517-2777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number16166
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: