Healthcare Provider Details

I. General information

NPI: 1194722868
Provider Name (Legal Business Name): PUTNAM VALLEY PEDIATRICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 MORRISSEY DR
PUTNAM VALLEY NY
10579-3018
US

IV. Provider business mailing address

4 MORRISSEY DR
PUTNAM VALLEY NY
10579-3018
US

V. Phone/Fax

Practice location:
  • Phone: 845-528-5222
  • Fax: 845-528-8589
Mailing address:
  • Phone: 845-528-5222
  • Fax: 845-528-8589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number118059
License Number StateNY

VIII. Authorized Official

Name: DR. WILLIAM MILLAR ZURHELLEN
Title or Position: CEO
Credential: M.D.
Phone: 845-528-5222