Basic Information
| Provider Information | |||||||||
| NPI: | 1790744035 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAMES | ||||||||
| FirstName: | PUSHPOM | ||||||||
| MiddleName: | Z | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 131 9TH STREET | ||||||||
| Address2: | APT 1C | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3475606044 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2460 HYLAN BLVD | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103063117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182265619 | ||||||||
| FaxNumber: | 7182265620 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2006 | ||||||||
| LastUpdateDate: | 09/01/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 01031819A | IN | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0214X | 01031819A | IN | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Pulmonology |
ID Information
| ID | Type | State | Issuer | Description | 03811323 | 05 | NY | MEDICAID |