PRIDE MEDICAL PLLC NPI 1922214600

NPI Information

  • NPI: 1922214600
  • Provider Name: PRIDE MEDICAL, PLLC
  • Classification: Clinic/Center - 261QP2300X
  • Specialization: Primary Care
  • Entity Type: Organization
  • CLIA Number: 33D1069476
  • Address: 3875 BROADWAY
    UNIT B
    NEW YORK, NY
    ZIP 10032
  • Phone: (917) 656-2951

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NPI Details

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:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QP2300XClinic/CenterPrimary CareNEW YORKYes

Other Identifiers

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

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11083700926OTHERNEW YORKNPI
2G99235MEDICARE UPINNEW YORK
311V951MEDICARE ID-TYPE UNSPECIFIEDNEW YORKPROVIDER NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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