MEDICARE: CHONLADA MOKRUE 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	207R00000X	Internal Medicine Physician	231662-1	NY

General Provider Information

NPI Number	:	1730136102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHONLADA MOKRUE M.D.

Provider Business Mailing Address
First Line	:	324 E 59TH ST APT 5A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-1549
Country	:	US
Telephone Number	:	646-354-0536
Fax Number	:

Provider Business Practice Location Address
First Line	:	2715 30TH AVE
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11102-2445
Country	:	US
Telephone Number	:	718-932-0007
Fax Number	:

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

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	05/01/2008

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