Provider Demographics
NPI:1538228481
Name:PRUTHI, REBECCA (DPM)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:PRUTHI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 E 86TH ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-1005
Mailing Address - Country:US
Mailing Address - Phone:917-520-8850
Mailing Address - Fax:
Practice Address - Street 1:450 FASHION AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10123-0101
Practice Address - Country:US
Practice Address - Phone:212-564-2331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005765213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery