Provider Demographics
NPI:1447742028
Name:YOADJARUST, NUTTAPOOM
Entity Type:Individual
Prefix:
First Name:NUTTAPOOM
Middle Name:
Last Name:YOADJARUST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 CENTRAL PARK W APT 1F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6020
Mailing Address - Country:US
Mailing Address - Phone:212-686-6321
Mailing Address - Fax:212-686-6329
Practice Address - Street 1:211 CENTRAL PARK W APT 1F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6020
Practice Address - Country:US
Practice Address - Phone:212-686-6321
Practice Address - Fax:212-686-6329
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant