MEDICARE: RUNGRADITH MINGPATUMKIJ L.AC

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	171100000X	Acupuncturist	006328	NY

General Provider Information

NPI Number	:	1386287126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUNGRADITH MINGPATUMKIJ L.AC

Provider Business Mailing Address
First Line	:	141 BARROW ST APT 2A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10014-6321
Country	:	US
Telephone Number	:	917-831-2414
Fax Number	:

Provider Business Practice Location Address
First Line	:	141 BARROW ST APT 2A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10014-6321
Country	:	US
Telephone Number	:	917-831-2414
Fax Number	:

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

Provider Enumeration Date	:	10/24/2019
Last Update Date	:	10/24/2019

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