Provider Demographics
NPI:1508131418
Name:PUTNAM PEDIATRIC MEDICINE, PLLC
Entity Type:Organization
Organization Name:PUTNAM PEDIATRIC MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-279-5131
Mailing Address - Street 1:667 STONELEIGH AVENUE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512
Mailing Address - Country:US
Mailing Address - Phone:845-279-9652
Mailing Address - Fax:845-279-3606
Practice Address - Street 1:667 STONELEIGH AVENUE
Practice Address - Street 2:SUITE 111
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512
Practice Address - Country:US
Practice Address - Phone:845-279-9652
Practice Address - Fax:845-279-3606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-12
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty