Provider Demographics
NPI:1407013543
Name:PUTTANNIAH, LUKSHMI KAMAT (MD)
Entity Type:Individual
Prefix:DR
First Name:LUKSHMI
Middle Name:KAMAT
Last Name:PUTTANNIAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 N DEAN ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2532
Mailing Address - Country:US
Mailing Address - Phone:201-308-3585
Mailing Address - Fax:201-301-8895
Practice Address - Street 1:155 N DEAN ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2532
Practice Address - Country:US
Practice Address - Phone:201-308-3585
Practice Address - Fax:201-301-8895
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2438892084P0800X, 2084P0804X
NJ25MA090602002084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry