Provider Demographics
NPI:1487862801
Name:PURANIK FAMILY MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:PURANIK FAMILY MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBERLLC
Authorized Official - Prefix:DR
Authorized Official - First Name:UJWALA
Authorized Official - Middle Name:P
Authorized Official - Last Name:PURANIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-237-1054
Mailing Address - Street 1:546 S BROAD ST STE 2E
Mailing Address - Street 2:UNIT 2E
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-6601
Mailing Address - Country:US
Mailing Address - Phone:203-237-1054
Mailing Address - Fax:203-237-9913
Practice Address - Street 1:546 S BROAD ST
Practice Address - Street 2:UNIT 2E
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-6600
Practice Address - Country:US
Practice Address - Phone:203-237-1054
Practice Address - Fax:203-237-9913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty