Healthcare Provider Details

I. General information

NPI: 1205912912
Provider Name (Legal Business Name): HENRY M. PUROW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1326 CLOVE RD
STATEN ISLAND NY
10301-4343
US

IV. Provider business mailing address

25 GRYMES HILL RD
STATEN ISLAND NY
10301-3818
US

V. Phone/Fax

Practice location:
  • Phone: 718-727-7272
  • Fax: 718-442-5370
Mailing address:
  • Phone: 718-720-7003
  • Fax: 718-442-5370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number103740
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: