Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 339172 | NY |
NPI | 1558795617 |
---|---|
Provider Name | Mutita Plabprasit Honsberger |
First Address | Purchase, NY 10577-2547 |
Second Address | New Hyde Park, NY 11042-1005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2013 |
Last Update Date | 20/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PENDING | (05) | NY |