Provider Demographics
NPI:1629091848
Name:PURI, RAJSHREE (MD)
Entity Type:Individual
Prefix:
First Name:RAJSHREE
Middle Name:
Last Name:PURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 471
Mailing Address - Street 2:
Mailing Address - City:MILLWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:10546
Mailing Address - Country:US
Mailing Address - Phone:914-361-6095
Mailing Address - Fax:914-371-1131
Practice Address - Street 1:12 N 7TH AVE
Practice Address - Street 2:DEPT OF PHYSICAL MEDICINE AND REHABILITATION
Practice Address - City:MT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2026
Practice Address - Country:US
Practice Address - Phone:914-361-6095
Practice Address - Fax:914-371-1131
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2010-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222202208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02180225Medicaid
NY02180225Medicaid
NYH49224Medicare UPIN