Healthcare Provider Details

I. General information

NPI: 1043254865
Provider Name (Legal Business Name): PRASERT ITHARAT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PARK AVE
YONKERS NY
10703-3402
US

IV. Provider business mailing address

PO BOX 998
YONKERS NY
10703-0998
US

V. Phone/Fax

Practice location:
  • Phone: 914-966-9787
  • Fax: 914-966-9793
Mailing address:
  • Phone: 914-966-9787
  • Fax: 914-966-9793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number127385
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: