1538336425 NPI number — PREETI V PUNTAMBEKAR M.D.

Table of content: PREETI V PUNTAMBEKAR M.D. (NPI 1538336425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538336425 NPI number — PREETI V PUNTAMBEKAR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PUNTAMBEKAR
Provider First Name:
PREETI
Provider Middle Name:
V
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538336425
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19 BRADHURST AVE STE 3850S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAWTHORNE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10532-2140
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-345-1313
Provider Business Mailing Address Fax Number:
914-345-5004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
633 ROUTE 37 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOMS RIVER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08755-8007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-240-4787
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/11/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084E0001X , with the licence number:  25MA09091400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084E0001X , with the licence number: 325811 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 25 MA09091400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0600X , with the licence number: 25MA09091400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 325811 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084N0600X , with the licence number: 325811 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)