Provider Demographics
NPI:1306871355
Name:PURSNANI, NEENA K (MD)
Entity type:Individual
Prefix:
First Name:NEENA
Middle Name:K
Last Name:PURSNANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:861 MARSHALL PHELPS ROAD
Mailing Address - Street 2:HEALTHONE WINDSOR FAMILY MEDICINE
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-2100
Mailing Address - Country:US
Mailing Address - Phone:860-683-0756
Mailing Address - Fax:860-683-1555
Practice Address - Street 1:851 MARSHALL PHELPS RD
Practice Address - Street 2:HEALTHONE WINDSOR FAMILY MEDICINE
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-2108
Practice Address - Country:US
Practice Address - Phone:860-683-0756
Practice Address - Fax:860-683-1555
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043378207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001433789Medicaid
CT080001774OtherRAILROAD MEDICARE
I43519Medicare UPIN
CT001433789Medicaid