Provider Demographics
NPI:1457443988
Name:PHALAKORNKUL, SUGANDA (MD)
Entity Type:Individual
Prefix:
First Name:SUGANDA
Middle Name:
Last Name:PHALAKORNKUL
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 1:186-20 HENLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA ESTATES
Mailing Address - State:NY
Mailing Address - Zip Code:11432
Mailing Address - Country:US
Mailing Address - Phone:718-264-7481
Mailing Address - Fax:718-334-6019
Practice Address - Street 1:7901 BROADWAY
Practice Address - Street 2:ELMHURST HOSPITAL CENTER , RM B2-01
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1329
Practice Address - Country:US
Practice Address - Phone:718-334-6023
Practice Address - Fax:718-334-6019
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYX0014701207R00000X, 207RC0200X
NYNYSX0014701207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02218202Medicaid
NYSP07V06010Medicare ID - Type Unspecified
NY02218202Medicaid