Healthcare Provider Details

I. General information

NPI: 1639170905
Provider Name (Legal Business Name): KERRY A PURTILL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ELM ST
TUCKAHOE NY
10707-3925
US

IV. Provider business mailing address

1 ELM ST
TUCKAHOE NY
10707-3925
US

V. Phone/Fax

Practice location:
  • Phone: 914-337-7474
  • Fax: 914-961-0058
Mailing address:
  • Phone: 914-337-7474
  • Fax: 914-961-0058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number224666
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: