Provider Demographics
NPI:1639107816
Name:GARG, PURNIMA
Entity Type:Individual
Prefix:
First Name:PURNIMA
Middle Name:
Last Name:GARG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:BRIARCLIFF MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10510-1135
Mailing Address - Country:US
Mailing Address - Phone:914-671-8097
Mailing Address - Fax:
Practice Address - Street 1:6585 BROADWAY
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-2050
Practice Address - Country:US
Practice Address - Phone:718-549-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210789173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01889798Medicaid
NYH12585Medicare UPIN
NY01889798Medicaid