Provider Demographics
NPI:1376770883
Name:PUTNAM OBSTETRICS & GYNECOLOGY P.C.
Entity Type:Organization
Organization Name:PUTNAM OBSTETRICS & GYNECOLOGY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANUSZ
Authorized Official - Middle Name:EMIL
Authorized Official - Last Name:RUDNICKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-279-2000
Mailing Address - Street 1:660 STONELEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-2466
Mailing Address - Country:US
Mailing Address - Phone:845-279-2000
Mailing Address - Fax:845-279-3887
Practice Address - Street 1:660 STONELEIGH AVE
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-2466
Practice Address - Country:US
Practice Address - Phone:845-279-2000
Practice Address - Fax:845-279-3887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150208261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY73A721Medicare UPIN