Mount Kisco Wellness Family Medicine PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MOUNT KISCO WELLNESS FAMILY MEDICINE PLLC

Practice address

666 Lexington Ave Ste 207a
Mount Kisco, NY 10549-3635

Phone

(917) 836-3892

NPI assigned

Jul 19, 2021

Last updated

Aug 3, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kulravee Puttharuska-Keegan, MD

Title

Provider/Owner

Phone

(917) 836-3892

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627948800000",
    "number": "1760055719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 64",
            "city": "TUCKAHOE",
            "state": "NY",
            "postal_code": "107070064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "666 LEXINGTON AVE STE 207A",
            "city": "MOUNT KISCO",
            "state": "NY",
            "postal_code": "105493635",
            "telephone_number": "917-836-3892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNT KISCO WELLNESS FAMILY MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-19",
        "last_updated": "2021-08-03",
        "certification_date": "2021-08-03",
        "status": "A",
        "authorized_official_last_name": "PUTTHARUSKA-KEEGAN",
        "authorized_official_first_name": "KULRAVEE",
        "authorized_official_title_or_position": "PROVIDER/OWNER",
        "authorized_official_telephone_number": "917-836-3892",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Mount Kisco, NY
• Providers in Mount Kisco, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.