Individual
DIMPLE PUTHETHUKUDI GEORGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N P
Contact information
Practice address
101 HOSPITAL ROAD, BROOK HAVEN HOSPITAL MEDICAL CENTER, PATCHOGUE, NY 11772
(631) 654-7214
Mailing address
70 DARE RD, SELDEN, NY 11784-2004
(631) 428-1645
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F307244
NY
Other
Enumeration date
07/28/2015
Last updated
07/28/2015
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