Healthcare Provider Details

I. General information

NPI: 1023505567
Provider Name (Legal Business Name): PHANTHIRA CHRISTINA TAMSUKHIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PHANTHIRA TAMSUKHIN

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 210TH ST
BRONX NY
10467-2401
US

IV. Provider business mailing address

3347 STEUBEN AVE FL 2
BRONX NY
10467-2805
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-6378
  • Fax:
Mailing address:
  • Phone: 718-920-6378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number312857
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number312857
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: