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General NPI Number Information
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NPI Number | 1659430403
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Entity Type | Individual
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Provider Name | PRASERT TANAPAT M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/07/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 23 ATLANTIC AVE
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City | FREEPORT
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State | NY
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Zip | 11520-5103
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Country | US
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Telephone | 516-379-5299
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Fax |
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Provider Business Mailing Address
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Address Line | 9 HORIZON RD
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City | GREAT NECK
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State | NY
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Zip | 11020-1143
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Country | US
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Telephone | 516-466-6317
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Fax | 516-466-6317
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | MD 113836
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License Number State | NY
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