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General NPI Number Information
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NPI Number | 1043597289
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Entity Type | Organization
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Legal Business Name | PUROW MD SHAPS MD PC
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Dates
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Enumeration Date | 11/15/2011
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Last Update Date | 01/28/2015
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Provider Practice Location Address
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Address Line | 2285 VICTORY BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10314-6625
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Country | US
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Telephone | 718-761-9386
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Fax |
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Provider Business Mailing Address
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Address Line | 2285 VICTORY BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10314-6625
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Country | US
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Telephone | 718-761-9386
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELIAS PUROW
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Credential | M.D.
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Telephone | 718-761-9386
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0800X
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Taxonomy Name | Endoscopy Clinic/Center
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License Number | 119659
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License Number State | NY
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