PRIDE MEDICAL PLLC NPI 1922214600

NPI Information

PRIDE MEDICAL, PLLC is a primary care clinic center in New York, NY. PRIDE MEDICAL, PLLC NPI is 1922214600. The provider is registered as an organization entity type.

The provider's business location address is:

3875 BROADWAY
UNIT B
NEW YORK, NY
ZIP 10032-567
Phone: (917) 656-2951

The provider's authorized official is Punyadech Photangtham .
The authorized official title is Owner and has the following contact phone number (917) 656-2951.

The CLIA number assigned to this NPI record is 33D1069476 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/16/2007 and was last updated on 11/23/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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