Provider Demographics
NPI:1205027109
Name:PUKENAS, ERIN W (MD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:W
Last Name:PUKENAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST STE SW200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1155
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:856-356-4710
Practice Address - Street 1:1 COOPER PLZ
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1461
Practice Address - Country:US
Practice Address - Phone:856-342-2425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD434580207LP3000X
NJMA082022207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ60033601OtherHORIZON NJ HEALTH
NJ3422388000OtherAMERIHEALTH/KEYSTONE/IBC
NJ010046002OtherAMERICHOICE
NJ60033604OtherHORIZON NJ HEALTH
NJ0139611Medicaid
NJ6645726OtherCIGNA
NJ2810681OtherUNITED HEALTHCARE
NJ9739093OtherAETNA
NJ0139611Medicaid