Provider Demographics
NPI:1184737744
Name:DULAI, POONAM S (MD)
Entity type:Individual
Prefix:DR
First Name:POONAM
Middle Name:S
Last Name:DULAI
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 1:2000 N VILLAGE AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-1078
Mailing Address - Country:US
Mailing Address - Phone:516-764-7940
Mailing Address - Fax:516-764-8521
Practice Address - Street 1:2000 N VILLAGE AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-1078
Practice Address - Country:US
Practice Address - Phone:516-764-7940
Practice Address - Fax:516-764-8521
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1964792084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F97045Medicare UPIN
55J361Medicare ID - Type Unspecified