Provider Demographics
NPI:1144323569
Name:PUNN, RAKESH KUMAR (MD)
Entity type:Individual
Prefix:
First Name:RAKESH
Middle Name:KUMAR
Last Name:PUNN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 PLAINVIEW ROAD
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714
Mailing Address - Country:US
Mailing Address - Phone:516-933-6654
Mailing Address - Fax:
Practice Address - Street 1:675 PLAINVIEW ROAD
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714
Practice Address - Country:US
Practice Address - Phone:516-933-6654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189680207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
0604044OtherAETNA HMO PEDIATRICS
5232172OtherAETNA PPO POS
44082542OtherATLANTIS HEALTH PLAN
010189680NY01OtherATHEM HEALTH NETWORK
3641974OtherAETNA HMO FAMILY PRACTICE
NY01616417Medicaid
054270OtherBETTER HEALTH ADVANTAGE
10H551OtherEMPIRE BCBS
795372OtherFIRST HEALTH HEALTHCARE C
5053949OtherBCE EMERGIS CORP
44082542OtherATLANTIS HEALTH PLAN
795372OtherFIRST HEALTH HEALTHCARE C