MEDICARE: SOMSAK BHITIYAKUL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	111158	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	566191	OTHER	NY	INDIVIDUAL MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366547663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOMSAK BHITIYAKUL M.D.

Provider Business Mailing Address
First Line	:	368 BROADWAY
Second Line	:	SUITE 201
City	:	KINGSTON
State	:	NY
Zip	:	12401-5160
Country	:	US
Telephone Number	:	845-339-5811
Fax Number	:	845-339-0708

Provider Business Practice Location Address
First Line	:	368 BROADWAY
Second Line	:	SUITE 201
City	:	KINGSTON
State	:	NY
Zip	:	12401-5160
Country	:	US
Telephone Number	:	845-339-5811
Fax Number	:	845-339-0708

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	03/13/2008

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Directions to “ SOMSAK BHITIYAKUL M.D.” Practice Location

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