Healthcare Provider Details

I. General information

NPI: 1285983015
Provider Name (Legal Business Name): NATHALLIE POKASUWAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2012
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5141 BROADWAY DEPARTMENT OF GERIATRICS AND PALLIATIVE CARE
NEW YORK NY
10034
US

IV. Provider business mailing address

5141 BROADWAY DEPARTMENT OF GERIATRICS AND PALLIATIVE CARE
NEW YORK NY
10034
US

V. Phone/Fax

Practice location:
  • Phone: 212-932-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD469516
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number265060
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number323184
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number323184
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: