Healthcare Provider Details

I. General information

NPI: 1043114572
Provider Name (Legal Business Name): INTHIRA TANGTONG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 HOLT DR
PEARL RIVER NY
10965-2001
US

IV. Provider business mailing address

247 HOLT DR
PEARL RIVER NY
10965-2001
US

V. Phone/Fax

Practice location:
  • Phone: 917-209-0706
  • Fax: 917-209-0706
Mailing address:
  • Phone: 917-209-0706
  • Fax: 917-209-0706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF356178
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: