Healthcare Provider Details

I. General information

NPI: 1598028243
Provider Name (Legal Business Name): MARISOL JENNIFER PUYANA MSED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

597 3RD AVE
TROY NY
12182-2509
US

IV. Provider business mailing address

2314 BROOKSHIRE DR
NISKAYUNA NY
12309-4838
US

V. Phone/Fax

Practice location:
  • Phone: 518-233-0544
  • Fax: 518-233-0703
Mailing address:
  • Phone: 518-280-4557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: