Provider Demographics
NPI:1619950532
Name:PURTILL, WILLIAM A (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:A
Last Name:PURTILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:990 STEWART AVE
Mailing Address - Street 2:SUITE L32
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530
Mailing Address - Country:US
Mailing Address - Phone:516-466-0485
Mailing Address - Fax:516-304-5394
Practice Address - Street 1:990 STEWART AVENUE
Practice Address - Street 2:SUITE L32
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530
Practice Address - Country:US
Practice Address - Phone:516-466-0485
Practice Address - Fax:516-304-5394
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY203061-02086S0129X
NY2030612086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01753699Medicaid
G51479Medicare UPIN
NYG51479Medicare UPIN