Healthcare Provider Details

I. General information

NPI: 1174628945
Provider Name (Legal Business Name): SOMSAK BHITIYAKUL, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

368 BROADWAY SUITE 201
KINGSTON NY
12401-5160
US

IV. Provider business mailing address

368 BROADWAY SUITE 201
KINGSTON NY
12401-5160
US

V. Phone/Fax

Practice location:
  • Phone: 845-339-5811
  • Fax: 845-339-0708
Mailing address:
  • Phone: 845-339-5811
  • Fax: 845-339-0708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number224184
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number111158
License Number StateNY

VIII. Authorized Official

Name: DR. SOMSAK BHITIYAKUL
Title or Position: OWNER
Credential: M.D.
Phone: 845-339-5811