Provider Demographics
NPI:1356423792
Name:S WIROJRATANA PC
Entity type:Organization
Organization Name:S WIROJRATANA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAWARNGWONG
Authorized Official - Middle Name:
Authorized Official - Last Name:WIROJRATANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-366-1260
Mailing Address - Street 1:610 SWAN STREET
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048-2424
Mailing Address - Country:US
Mailing Address - Phone:716-366-1260
Mailing Address - Fax:716-366-1904
Practice Address - Street 1:610 SWAN STREET
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-2424
Practice Address - Country:US
Practice Address - Phone:716-366-1260
Practice Address - Fax:716-366-1904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1179791OtherGHI
NY00629901Medicaid
B33053Medicare UPIN
NYB33053Medicare ID - Type Unspecified