Provider Demographics
NPI:1619936622
Name:PURUGGANAN, SYLVIA M (MD)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:M
Last Name:PURUGGANAN
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:239 GOLDEN HILL LN
Mailing Address - Street 2:ULSTER COUNTY DEPARTMENT OF MENTAL HEALTH
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-6441
Mailing Address - Country:US
Mailing Address - Phone:845-340-4000
Mailing Address - Fax:845-340-4070
Practice Address - Street 1:239 GOLDEN HILL LN
Practice Address - Street 2:ULSTER COUNTY DEPARTMENT OF MENTAL HEALTH
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-6441
Practice Address - Country:US
Practice Address - Phone:845-340-4000
Practice Address - Fax:845-340-4070
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0410882084P0800X, 2084P0805X
NY1542472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001410886Medicaid
CT001410886Medicaid
CT260004007Medicare ID - Type Unspecified