Provider Demographics
NPI:1790048445
Name:PURI, ANUPAM (MA)
Entity Type:Individual
Prefix:MRS
First Name:ANUPAM
Middle Name:
Last Name:PURI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BIRCHWOOD PARK DR
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-6418
Mailing Address - Country:US
Mailing Address - Phone:516-822-5466
Mailing Address - Fax:516-822-5254
Practice Address - Street 1:25 BIRCHWOOD PARK DR
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-6418
Practice Address - Country:US
Practice Address - Phone:516-822-5466
Practice Address - Fax:516-822-5254
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1482130174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist