Provider Demographics
NPI:1578966412
Name:PUMA, CARLO
Entity Type:Individual
Prefix:
First Name:CARLO
Middle Name:
Last Name:PUMA
Suffix:
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 1:129 BARCLAY LN
Mailing Address - Street 2:
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477-5201
Mailing Address - Country:US
Mailing Address - Phone:845-247-3278
Mailing Address - Fax:
Practice Address - Street 1:129 BARCLAY LN
Practice Address - Street 2:
Practice Address - City:SAUGERTIES
Practice Address - State:NY
Practice Address - Zip Code:12477-5201
Practice Address - Country:US
Practice Address - Phone:845-247-3278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294617164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse