Basic Information
| Provider Information | |||||||||
| NPI: | 1467199604 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RATANACHAIYAPHAN | ||||||||
| FirstName: | SUTIKANT | ||||||||
| MiddleName: | |||||||||
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| Credential: | LAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1255 5TH AVE - SUITE 6L | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100293996 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144001500 | ||||||||
| FaxNumber: | 9144788781 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 HANSON PL STE 704 | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112432907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188571900 | ||||||||
| FaxNumber: | 7188571902 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2022 | ||||||||
| LastUpdateDate: | 10/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | 005960 | NY | Y | Other Service Providers | Acupuncturist |
No ID Information.