Healthcare Provider Details

I. General information

NPI: 1801769450
Provider Name (Legal Business Name): DENCY PULIMTHANATHU DAVID
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7925 WINCHESTER BLVD
QUEENS VILLAGE NY
11427-2128
US

IV. Provider business mailing address

78 LUCILLE AVE
ELMONT NY
11003-2722
US

V. Phone/Fax

Practice location:
  • Phone: 718-464-7500
  • Fax:
Mailing address:
  • Phone: 516-451-7512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number893684-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: