Provider Demographics
NPI:1487636254
Name:PULEO, JAMES V II
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:V
Last Name:PULEO
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 WASHINGTON AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-1040
Mailing Address - Country:US
Mailing Address - Phone:518-438-4483
Mailing Address - Fax:518-482-4201
Practice Address - Street 1:1375 WASHINGTON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-1040
Practice Address - Country:US
Practice Address - Phone:518-438-4483
Practice Address - Fax:518-482-4201
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190197207R00000X, 207RG0100X, 207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01701275Medicaid
NYRA9234Medicare PIN
NYF93321Medicare UPIN