Provider Demographics
NPI:1740455195
Name:EAPEN-PULIPATI, DIMPLE (MD)
Entity type:Individual
Prefix:
First Name:DIMPLE
Middle Name:
Last Name:EAPEN-PULIPATI
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 1:475 E MAIN ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-3121
Mailing Address - Country:US
Mailing Address - Phone:631-654-2386
Mailing Address - Fax:631-447-3852
Practice Address - Street 1:475 E MAIN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3121
Practice Address - Country:US
Practice Address - Phone:631-654-2386
Practice Address - Fax:631-447-3852
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY248202207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400032146Medicare PIN