Provider Demographics
NPI:1033483151
Name:SIRIAMONTHEP, ONGARJ (RPH)
Entity Type:Individual
Prefix:MR
First Name:ONGARJ
Middle Name:
Last Name:SIRIAMONTHEP
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MAIN STREET
Mailing Address - Street 2:ROOSEVELT ISLAND
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10044-0052
Mailing Address - Country:US
Mailing Address - Phone:212-318-4057
Mailing Address - Fax:212-318-4351
Practice Address - Street 1:1 MAIN ST
Practice Address - Street 2:ROOSEVELT ISLAND
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10044-0052
Practice Address - Country:US
Practice Address - Phone:212-318-4057
Practice Address - Fax:212-318-4351
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35272183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist