Provider Demographics
NPI:1043523780
Name:DPMPUNNIPRPA LLC
Entity type:Organization
Organization Name:DPMPUNNIPRPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NYEOTI
Authorized Official - Middle Name:
Authorized Official - Last Name:PUNNI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:609-334-0700
Mailing Address - Street 1:1923 WELSH RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-4659
Mailing Address - Country:US
Mailing Address - Phone:215-677-3222
Mailing Address - Fax:215-677-3241
Practice Address - Street 1:1923 WELSH RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-4659
Practice Address - Country:US
Practice Address - Phone:215-677-3222
Practice Address - Fax:215-677-3241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-23
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006182213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA189575Medicare PIN