Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 271391-1 | NY |
NPI | 1356504302 |
---|---|
Provider Name | Suda Jirasakuldej |
First Address | New York, NY 10032-3726 |
Second Address | New York, NY 10032-3726 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2008 |
Last Update Date | 16/07/2014 |