Healthcare Provider Details

I. General information

NPI: 1093812513
Provider Name (Legal Business Name): PUNNGSRI SUWANKOSAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 BEACH 19TH ST
FAR ROCKAWAY NY
11691-4423
US

IV. Provider business mailing address

327 BEACH 19TH ST
FAR ROCKAWAY NY
11691-4423
US

V. Phone/Fax

Practice location:
  • Phone: 718-869-7335
  • Fax:
Mailing address:
  • Phone: 718-869-7335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number119616-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: