Basic Information
| Provider Information | |||||||||
| NPI: | 1376770883 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PUTNAM OBSTETRICS & GYNECOLOGY P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 660 STONELEIGH AVE | ||||||||
| Address2: | |||||||||
| City: | CARMEL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105122466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452792000 | ||||||||
| FaxNumber: | 8452793887 | ||||||||
| Practice Location | |||||||||
| Address1: | 660 STONELEIGH AVE | ||||||||
| Address2: | |||||||||
| City: | CARMEL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105122466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452792000 | ||||||||
| FaxNumber: | 8452793887 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2009 | ||||||||
| LastUpdateDate: | 07/15/2009 | ||||||||
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| AuthorizedOfficialLastName: | RUDNICKI | ||||||||
| AuthorizedOfficialFirstName: | JANUSZ | ||||||||
| AuthorizedOfficialMiddleName: | EMIL | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8452792000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2500X | 150208 | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
No ID Information.