Healthcare Provider Details

I. General information

NPI: 1790744035
Provider Name (Legal Business Name): PUSHPOM Z JAMES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 HYLAN BLVD
STATEN ISLAND NY
10306-3117
US

IV. Provider business mailing address

131 9TH STREET APT 1C
BROOKLYN NY
11209
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-5619
  • Fax: 718-226-5620
Mailing address:
  • Phone: 347-560-6044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01031819A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number01031819A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: