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General NPI Number Information
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NPI Number | 1649303058
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Entity Type | Organization
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Legal Business Name | PEDIATRIC ASSOCIATES OF PUTNAM
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 11/03/2008
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Provider Practice Location Address
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Address Line | 667 STONELEIGH AVE SUITE 116
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City | CARMEL
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State | NY
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Zip | 10512-2454
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Country | US
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Telephone | 845-279-9652
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Fax | 845-279-3606
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Provider Business Mailing Address
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Address Line | 667 STONELEIGH AVE SUITE 116
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City | CARMEL
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State | NY
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Zip | 10512-2454
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Country | US
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Telephone | 845-279-9652
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Fax | 845-279-3606
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Authorized Official
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Title or Position | MEDICAL BILLER
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Name | MRS. SUZANNE BENNIE
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Credential |
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Telephone | 845-279-9652
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 111285
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License Number State | NY
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