Provider Demographics
NPI:1437113750
Name:ANGKUSTSIRI, SURACHANEE (MD)
Entity Type:Individual
Prefix:DR
First Name:SURACHANEE
Middle Name:
Last Name:ANGKUSTSIRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 MADISON ST
Mailing Address - Street 2:DEPT. OB-GYN 2ND FL. GOUVERNEUR HEALTHCARE SERVICES
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-7537
Mailing Address - Country:US
Mailing Address - Phone:212-238-7227
Mailing Address - Fax:212-238-7284
Practice Address - Street 1:227 MADISON ST
Practice Address - Street 2:OB GYN RM 228
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-7537
Practice Address - Country:US
Practice Address - Phone:212-238-7244
Practice Address - Fax:212-238-7284
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119011207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY26K402Medicare PIN