MEDICARE: PITAYA CHAITUM RDMS, RDCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	246X00000X	Cardiovascular Specialist/Technologist
2	246XC2903X	Vascular Specialist/Technologist Cardiovascular
3	246XS1301X	Sonography Specialist/Technologist Cardiovascular
4	2471S1302X	Sonography Radiologic Technologist

General Provider Information

NPI Number	:	1992074132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PITAYA CHAITUM RDMS, RDCS

Provider Business Mailing Address
First Line	:	592 RIVER RD
Second Line	:
City	:	NEW MILFORD
State	:	NJ
Zip	:	07646-2914
Country	:	US
Telephone Number	:	201-667-0327
Fax Number	:

Provider Business Practice Location Address
First Line	:	592 RIVER RD
Second Line	:
City	:	NEW MILFORD
State	:	NJ
Zip	:	07646-2914
Country	:	US
Telephone Number	:	201-667-0327
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2011
Last Update Date	:	04/14/2014

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