Provider Demographics
NPI:1922153048
Name:PURO, DAVID MARK (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MARK
Last Name:PURO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6917 SHORE RD
Mailing Address - Street 2:STE 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-1000
Mailing Address - Country:US
Mailing Address - Phone:718-692-1292
Mailing Address - Fax:718-692-1292
Practice Address - Street 1:6917 SHORE RD
Practice Address - Street 2:STE 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-1000
Practice Address - Country:US
Practice Address - Phone:718-692-1292
Practice Address - Fax:718-692-1292
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY508451103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU24151Medicare ID - Type Unspecified