Healthcare Provider Details

I. General information

NPI: 1487017356
Provider Name (Legal Business Name): GEORGE JOJO PUNNAKUDIYIL M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 SUNRISE HWY
WEST BABYLON NY
11704-5909
US

IV. Provider business mailing address

125 WESTWOOD DR APT 142
WESTBURY NY
11590-1624
US

V. Phone/Fax

Practice location:
  • Phone: 516-736-9468
  • Fax:
Mailing address:
  • Phone: 973-782-3048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number300115
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: