Provider Demographics
NPI:1861208373
Name:SUREEYATHANAPHAT, PHANTHAPHAN (MD)
Entity type:Individual
Prefix:MS
First Name:PHANTHAPHAN
Middle Name:
Last Name:SUREEYATHANAPHAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 FORT WASHINGTON AVENUE, 6TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3729
Mailing Address - Country:US
Mailing Address - Phone:212-305-2708
Mailing Address - Fax:212-342-3660
Practice Address - Street 1:161 FORT WASHINGTON AVENUE, 6TH FLOOR
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3729
Practice Address - Country:US
Practice Address - Phone:212-305-2708
Practice Address - Fax:212-342-3660
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337162207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00243178Medicaid