Provider Demographics
NPI:1669651121
Name:PUTNAM CARDIO PULMONARY SERVICES, P.C.
Entity Type:Organization
Organization Name:PUTNAM CARDIO PULMONARY SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MADDIPOTI
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHOUDRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-279-2209
Mailing Address - Street 1:112 CLOCK TOWER COMMONS
Mailing Address - Street 2:BLDG 1
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-4055
Mailing Address - Country:US
Mailing Address - Phone:845-279-2209
Mailing Address - Fax:
Practice Address - Street 1:112 CLOCK TOWER COMMONS
Practice Address - Street 2:BLDG 1
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-4055
Practice Address - Country:US
Practice Address - Phone:845-279-2209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129945207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW12511OtherMEDICARE ID