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General NPI Number Information
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NPI Number | 1790954949
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Entity Type | Organization
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Legal Business Name | PRASERT ITHARAT, MD
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Dates
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Enumeration Date | 02/21/2008
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Last Update Date | 03/27/2008
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Provider Practice Location Address
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Address Line | 249 PARK AVE
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City | YONKERS
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State | NY
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Zip | 10703-2405
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Country | US
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Telephone | 914-963-0042
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Fax | 914-964-7948
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Provider Business Mailing Address
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Address Line | 249 PARK AVE
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City | YONKERS
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State | NY
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Zip | 10703-2405
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Country | US
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Telephone | 914-963-0042
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Fax | 914-964-7948
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Authorized Official
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Title or Position | PRESIDENT
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Name | PRASERT ITHARAT
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Credential | MD
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Telephone | 914-963-0042
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 127385
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License Number State | NY
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