Provider Demographics
NPI:1245226778
Name:PUTMAN, WILLIAM ERSKINE (MD, FACP)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ERSKINE
Last Name:PUTMAN
Suffix:
Gender:M
Credentials:MD, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 E LOOP RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-1143
Mailing Address - Country:US
Mailing Address - Phone:718-351-2113
Mailing Address - Fax:718-351-2044
Practice Address - Street 1:7611 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3303
Practice Address - Country:US
Practice Address - Phone:718-238-9065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174762207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01109571Medicaid
NY01109571Medicaid
NYA62521Medicare UPIN