Provider Demographics
NPI:1174628945
Name:SOMSAK BHITIYAKUL, M.D., P.C.
Entity Type:Organization
Organization Name:SOMSAK BHITIYAKUL, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SOMSAK
Authorized Official - Middle Name:
Authorized Official - Last Name:BHITIYAKUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-339-5811
Mailing Address - Street 1:368 BROADWAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-5160
Mailing Address - Country:US
Mailing Address - Phone:845-339-5811
Mailing Address - Fax:845-339-0708
Practice Address - Street 1:368 BROADWAY
Practice Address - Street 2:SUITE 201
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-5160
Practice Address - Country:US
Practice Address - Phone:845-339-5811
Practice Address - Fax:845-339-0708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224184207R00000X
NY111158207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWZT6X1Medicare PIN