Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 201156 | NY |
NPI | 1013078591 |
---|---|
Provider Name | Dr. Tess Saju Punnapuzha |
First Address | Mamaroneck, NY 10543-1012 |
Second Address | Brooklyn, NY 11207-3509 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 30/03/2015 |