Provider Demographics
NPI:1003183021
Name:PUERTO, DENISE C
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:C
Last Name:PUERTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 W 140TH ST
Mailing Address - Street 2:5-B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10030-1783
Mailing Address - Country:US
Mailing Address - Phone:917-574-9499
Mailing Address - Fax:
Practice Address - Street 1:213 W 140TH ST
Practice Address - Street 2:5-B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10030-1783
Practice Address - Country:US
Practice Address - Phone:917-574-9499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306819-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse