Provider Demographics
NPI:1316053259
Name:PUNSAL, REYNALDO MANUBAY (MD)
Entity type:Individual
Prefix:
First Name:REYNALDO
Middle Name:MANUBAY
Last Name:PUNSAL
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 1:73 JOYCE RD
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-3939
Mailing Address - Country:US
Mailing Address - Phone:516-225-5518
Mailing Address - Fax:516-625-0747
Practice Address - Street 1:247 WALT WHITMAN RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-4119
Practice Address - Country:US
Practice Address - Phone:631-923-2450
Practice Address - Fax:631-923-2451
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154892207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F21252Medicare UPIN
58F452Medicare ID - Type Unspecified