Individual
FNU POONAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
101 SAINT ANDREWS LN, GLEN COVE, NY 11542-2254
(516) 674-7300
Mailing address
1100 AVALON SQ APT 1305, GLEN COVE, NY 11542-2877
(718) 629-7458
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
327158
NY
207R00000X
Internal Medicine Physician
A208249
CA
Other
Enumeration date
11/24/2020
Last updated
06/25/2026
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