Provider Demographics
NPI:1144557596
Name:PREMIER ORTHOPEDIC SURGERY AND SPORTS MEDICINE, PLLC
Entity type:Organization
Organization Name:PREMIER ORTHOPEDIC SURGERY AND SPORTS MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:A
Authorized Official - Last Name:PUTTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-231-0300
Mailing Address - Street 1:1800 WALT WHITMAN RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3099
Mailing Address - Country:US
Mailing Address - Phone:631-231-0300
Mailing Address - Fax:631-231-3331
Practice Address - Street 1:1800 WALT WHITMAN RD
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3099
Practice Address - Country:US
Practice Address - Phone:631-231-0300
Practice Address - Fax:631-231-3331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-05
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty