Provider Demographics
NPI:1790744035
Name:JAMES, PUSHPOM Z (MD)
Entity Type:Individual
Prefix:
First Name:PUSHPOM
Middle Name:Z
Last Name:JAMES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:131 9TH STREET
Mailing Address - Street 2:APT 1C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209
Mailing Address - Country:US
Mailing Address - Phone:347-560-6044
Mailing Address - Fax:
Practice Address - Street 1:2460 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-3117
Practice Address - Country:US
Practice Address - Phone:718-226-5619
Practice Address - Fax:718-226-5620
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031819A208000000X, 2080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03811323Medicaid
NY03811323Medicaid
C01711Medicare UPIN
IN000000690077OtherANTHEM
INM400036704Medicare PIN