Provider Demographics
NPI:1861717175
Name:BOONSIRI, JOSEPH ISADHA (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ISADHA
Last Name:BOONSIRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 1ST AVE
Mailing Address - Street 2:2ND FLOOR RADIOLOGY
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3295
Mailing Address - Country:US
Mailing Address - Phone:734-341-5711
Mailing Address - Fax:
Practice Address - Street 1:660 1ST AVE
Practice Address - Street 2:2ND FLOOR RADIOLOGY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3295
Practice Address - Country:US
Practice Address - Phone:212-263-5219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2792622085N0700X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology