Provider Demographics
NPI:1205912912
Name:PUROW, HENRY M (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:M
Last Name:PUROW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 GRYMES HILL RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-3818
Mailing Address - Country:US
Mailing Address - Phone:718-720-7003
Mailing Address - Fax:718-442-5370
Practice Address - Street 1:1326 CLOVE RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-4343
Practice Address - Country:US
Practice Address - Phone:718-727-7272
Practice Address - Fax:718-442-5370
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY103740208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB79682Medicare UPIN