MEDICARE: DR. AMIT PUNJ DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN013168	GA
2	1223G0001X	General Practice Dentistry	019.027312	IL

General Provider Information

NPI Number	:	1013019629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMIT PUNJ DMD

Provider Business Mailing Address
First Line	:	3450 WAYNE AVE
Second Line	:	APT 13 H
City	:	BRONX
State	:	NY
Zip	:	10467-2510
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3450 WAYNE AVE
Second Line	:	APT 13 H
City	:	BRONX
State	:	NY
Zip	:	10467-2510
Country	:	US
Telephone Number	:	918-850-1030
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2006
Last Update Date	:	08/20/2012

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