Provider Demographics
NPI:1558728238
Name:PUERTA, DAVID ARTURO (MA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ARTURO
Last Name:PUERTA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5049 67TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-7549
Mailing Address - Country:US
Mailing Address - Phone:347-549-1498
Mailing Address - Fax:
Practice Address - Street 1:5040 JACOBUS ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-3702
Practice Address - Country:US
Practice Address - Phone:718-429-7006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026689235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist