Healthcare Provider Details

I. General information

NPI: 1043523780
Provider Name (Legal Business Name): DPMPUNNIPRPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2010
Last Update Date: 12/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 WELSH RD
PHILADELPHIA PA
19115-4659
US

IV. Provider business mailing address

1923 WELSH RD
PHILADELPHIA PA
19115-4659
US

V. Phone/Fax

Practice location:
  • Phone: 215-677-3222
  • Fax: 215-677-3241
Mailing address:
  • Phone: 215-677-3222
  • Fax: 215-677-3241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC006182
License Number StatePA

VIII. Authorized Official

Name: NYEOTI PUNNI
Title or Position: OWNER
Credential: DPM
Phone: 609-334-0700