Provider Demographics
NPI:1851581656
Name:PUSKURI, PRANEETHA (MD)
Entity Type:Individual
Prefix:
First Name:PRANEETHA
Middle Name:
Last Name:PUSKURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 REINHART WAY
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-5710
Mailing Address - Country:US
Mailing Address - Phone:732-309-1040
Mailing Address - Fax:
Practice Address - Street 1:22 REINHART WAY
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-5710
Practice Address - Country:US
Practice Address - Phone:732-309-1040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08271100207R00000X
TXM9589207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine