1801825096 NPI number — PANUS ROMSAITONG MD

Table of content: PANUS ROMSAITONG MD (NPI 1801825096)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801825096 NPI number — PANUS ROMSAITONG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROMSAITONG
Provider First Name:
PANUS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801825096
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
440 W BAY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONG BEACH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11561-1838
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-896-5255
Provider Business Mailing Address Fax Number:
718-896-5270

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9876 QUEENS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REGO PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11374-4511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-897-0300
Provider Business Practice Location Address Fax Number:
718-897-3330
Provider Enumeration Date:
07/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  209009 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01914878 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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