Provider Demographics
NPI:1780647487
Name:PUTTER, ELLEN C (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:C
Last Name:PUTTER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:20 PLAZA ST E
Mailing Address - Street 2:APT A7
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-4955
Mailing Address - Country:US
Mailing Address - Phone:718-857-5500
Mailing Address - Fax:718-857-5533
Practice Address - Street 1:20 PLAZA ST E
Practice Address - Street 2:APT A7
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-4955
Practice Address - Country:US
Practice Address - Phone:718-857-5500
Practice Address - Fax:718-857-5533
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY192278208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG05628Medicare UPIN