MEDICARE: RAJSHREE PURI MD

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	208100000X	Physical Medicine & Rehabilitation Physician	222202	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629091848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAJSHREE PURI MD

Provider Business Mailing Address
First Line	:	PO BOX 471
Second Line	:
City	:	MILLWOOD
State	:	NY
Zip	:	10546
Country	:	US
Telephone Number	:	914-361-6095
Fax Number	:	914-371-1131

Provider Business Practice Location Address
First Line	:	12 N 7TH AVE
Second Line	:	DEPT OF PHYSICAL MEDICINE AND REHABILITATION
City	:	MT VERNON
State	:	NY
Zip	:	10550-2026
Country	:	US
Telephone Number	:	914-361-6095
Fax Number	:	914-371-1131

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	02/20/2010

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